- Email: [email protected]
Dementia in Parkinson's Disease
716
Abstracts / Neurobiology of Aging 35 (2014) 715–724
enhances the capacity to acquire a broader knowledge-based of general information to process data in a more systematic manner. Another approach would be using functional assessment scales such as FAST as a valuable way to overcome the negative influence of illiteracy on cognitive function. Conclusions. Considering the high ratio of illiteracy and low-level of education among the elderly population of Middle Eastern countries, the role of illiteracy as a risk factor for Alzheimer’s disease on the one hand and the necessity of early detection of cognitive decline in this population on the other, it seems there is still a caveat for developing translated and/ or culturally adapted versions of neuropsychological instruments to establish appropriate cut-points for the target populations. Regardless of the high value of functional scales in the evaluation of dementia in these population, our experiences also reflects the usefulness of the new scales based on culturally-related information such as proverbs for assessment of abstract thinking in the executive functions as well as ethnicity-related rituals which could be helpful in the more precise investigation of cognitive function while minimal impact of low level of education on tests results is detected.
Methods. We included consecutive early onset AD patients admitted to our Behavioural Neurology and Dementia outpatient clinic between September 2011 and January 2012 in the study. Results. There were 48 early onset AD patients. Female/male ratio was 0.92. Mean age at symptom onset was 53.32 (36-64) years, mean age at onset was 56.82 (41-66) years. Mean education duration was 4.96 years. Mean follow-up time was 2.84 years. Mean MMSE and CDR scores at first visit were 13.34 and 1.66 respectively. The first symptom was memory impairment in 79.16% (n¼38) of patients followed by executive dysfunction (n¼6), language impairment (n¼2) and visuospatial dysfunction (n¼2). The female/male ratio is lower than in the late onset AD cohort in our department. The duration of education and CDR at first visit were similar to late onset AD patients. The frequency of cognitive domains other than memory as initial presentation was higher in early-onset AD patients. The rate of decline in MMSE and CDR was slower in early onset AD patients. Conclusions. The frequency of early onset AD is increasing. Studies show that early and late onset AD have different characteristics in terms of clinical features.
Dementia in Parkinson’s Disease ATRIAL FIBRILLATION PREDICTS COGNITIVE IMPAIRMENT IN PATIENTS WITH ISCHEMIC STROKE a
b
DEMENTIA IN PARKINSON’S DISEASE
b a
Eliyahu Mizrahi , Marina Arad , Abraham Adunsky . The Geriatric And Rehabilitation Center “Shmuel-Harofe”, Geriatric and Rehabilitation B, Affilated with the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; b The Sheba Medical Center, Geriatric and Rehabilitation B, Affilated with the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
Objectives. Atrial fibrillation (AF) is considered as a risk factor for cognitive impairment.
Methods. This retrospective chart review study was conducted in a patient stroke rehabilitation ward of a university-affiliated referral hospital. The participants were 707 patients admitted for a standard rehabilitation course after an ischemic stroke. Cognitive status was assessed by the Mini-Mental State Examination (MMSE), and scores lower than 24 points were considered as suggestive of cognitive impairment. Results. Atrial fibrillation, age, gender, diabetes, and dementia emerged as the only statistically significant parameters differing between those with MMSE score lower than 24 or higher. In a multiple logistic regression analysis, AF (odds ratio 1.6, 95% confidence interval 1.03-2.47, P ¼ .03) was associated with an increased risk of cognitive impairment. Conclusions. Our findings suggest that atrial fibrillation upon admission is independently associated with lower MMSE scores in patients with ischemic stroke.
CAUSES OF EARLY-ONSET DEMENTIA IN A TERTIARY REFERRAL CENTER IN ISTANBUL Baris Topcular a, Neslihan Behrem b, Mesude Ozerden b, Nazan K. Sakalli b, Ayca Altınkaya a, Aysenur Kaymaz a, Ahmet Yabalak a, Dursun Kirbas b, Gulsen A. Demır a. a Istanbul Bilim University, Department of Neurology, Istanbul, Turkey; b Bakirkoy Prof. Dr. Mazhar Osman Teaching And Research Hospital, Department of Neurology, Istanbul, Turkey
Objectives. Early-onset dementia is defined as dementia before 65 years
of age. The prevalence of dementia <65 years of age is approximately 54260/100,000. Studies on early onset Alzheimer’s dementia (AD) show different clinical and sociodemographic features compared to late onset AD. We aimed to study the clinical and sociodemographic features of early onset AD patients in our department.
Murat Emre. University of Istanbul, Faculty of Medicine, Department of Neurology, Istanbul, Turkey
In contrast to the classical perception of Parkinson’s disease (PD) mainly as a motor disorder, cognitive impairment and dementia has been increasingly more recognized as associated features of PD over the last few decades. Subtle cognitive deficits are found in most studies comparing PD patients with normal controls, also in those conducted in newly diagnosed patiens. The incidence of dementia is susbtantially increased in patients with PD, 4-6 times higher rates than controls and point-prevalence of approximately 30% have been reported. The main risk factors are old age and the akinetic-rigid form of the disease. Presence of subtle deficits in executive functions, verbal fluency, and early development of psychosis on dopaminergic medication are also risk factors for incipient dementia. The typical cognitive profile of dementia in PD is a dysexecutive syndrome with impaired and fluctuating attention, apathy, prominent impairment of executive and visuo-spatial functions. Memory impairment is frequent, but it is usually different than that seen in Alzheimer’s disease with impaired free recall, but relatively better recognition. Core language functions are largely preserved except for reduced verbal fluency and anomia. Personality changes and behavioral symptoms such as hallucinations are frequent. The assessment and diagnosis of dementia in PD involves two steps. First, dementia syndrome should be differentiated from conditions which can mimic dementia, such as depression and confusion. Once the presence of dementia syndrome is ascertained the second step involves differential diagnosis in order to exclude other disorders with combined dementia and parkinsonism. The most consistent neurotransmitter deficit associated with PDD is cholinergic, clinical trials using cholinesterase inhibitors (ChE-I) have been conducted. A number of small studies with different ChE-I and large randomized, placebo controlled trials with rivastigmine and donepezil revealed that ChE-I can be beneficial in PDD patients, rivastigmine has been approved as the first treatment for PDD.
THE EFFECTS OF SYMPTOMS AND MEDICATION ON WORKING MEMORY IN PARKINSONISM Ahmed H. Mostafa a, Peter Bell a, Doaa H. Hewedi b, Abeer M. Eissa b. a University of Western Sydney, School of Social Sciences and Psychology, Sydney, Australia; b Ain Shams University, Faculty of Medicine, Department of Psychogeriatrics
Abstracts / Neurobiology of Aging 35 (2014) 715–724
enhances the capacity to acquire a broader knowledge-based of general information to process data in a more systematic manner. Another approach would be using functional assessment scales such as FAST as a valuable way to overcome the negative influence of illiteracy on cognitive function. Conclusions. Considering the high ratio of illiteracy and low-level of education among the elderly population of Middle Eastern countries, the role of illiteracy as a risk factor for Alzheimer’s disease on the one hand and the necessity of early detection of cognitive decline in this population on the other, it seems there is still a caveat for developing translated and/ or culturally adapted versions of neuropsychological instruments to establish appropriate cut-points for the target populations. Regardless of the high value of functional scales in the evaluation of dementia in these population, our experiences also reflects the usefulness of the new scales based on culturally-related information such as proverbs for assessment of abstract thinking in the executive functions as well as ethnicity-related rituals which could be helpful in the more precise investigation of cognitive function while minimal impact of low level of education on tests results is detected.
Methods. We included consecutive early onset AD patients admitted to our Behavioural Neurology and Dementia outpatient clinic between September 2011 and January 2012 in the study. Results. There were 48 early onset AD patients. Female/male ratio was 0.92. Mean age at symptom onset was 53.32 (36-64) years, mean age at onset was 56.82 (41-66) years. Mean education duration was 4.96 years. Mean follow-up time was 2.84 years. Mean MMSE and CDR scores at first visit were 13.34 and 1.66 respectively. The first symptom was memory impairment in 79.16% (n¼38) of patients followed by executive dysfunction (n¼6), language impairment (n¼2) and visuospatial dysfunction (n¼2). The female/male ratio is lower than in the late onset AD cohort in our department. The duration of education and CDR at first visit were similar to late onset AD patients. The frequency of cognitive domains other than memory as initial presentation was higher in early-onset AD patients. The rate of decline in MMSE and CDR was slower in early onset AD patients. Conclusions. The frequency of early onset AD is increasing. Studies show that early and late onset AD have different characteristics in terms of clinical features.
Dementia in Parkinson’s Disease ATRIAL FIBRILLATION PREDICTS COGNITIVE IMPAIRMENT IN PATIENTS WITH ISCHEMIC STROKE a
b
DEMENTIA IN PARKINSON’S DISEASE
b a
Eliyahu Mizrahi , Marina Arad , Abraham Adunsky . The Geriatric And Rehabilitation Center “Shmuel-Harofe”, Geriatric and Rehabilitation B, Affilated with the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; b The Sheba Medical Center, Geriatric and Rehabilitation B, Affilated with the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
Objectives. Atrial fibrillation (AF) is considered as a risk factor for cognitive impairment.
Methods. This retrospective chart review study was conducted in a patient stroke rehabilitation ward of a university-affiliated referral hospital. The participants were 707 patients admitted for a standard rehabilitation course after an ischemic stroke. Cognitive status was assessed by the Mini-Mental State Examination (MMSE), and scores lower than 24 points were considered as suggestive of cognitive impairment. Results. Atrial fibrillation, age, gender, diabetes, and dementia emerged as the only statistically significant parameters differing between those with MMSE score lower than 24 or higher. In a multiple logistic regression analysis, AF (odds ratio 1.6, 95% confidence interval 1.03-2.47, P ¼ .03) was associated with an increased risk of cognitive impairment. Conclusions. Our findings suggest that atrial fibrillation upon admission is independently associated with lower MMSE scores in patients with ischemic stroke.
CAUSES OF EARLY-ONSET DEMENTIA IN A TERTIARY REFERRAL CENTER IN ISTANBUL Baris Topcular a, Neslihan Behrem b, Mesude Ozerden b, Nazan K. Sakalli b, Ayca Altınkaya a, Aysenur Kaymaz a, Ahmet Yabalak a, Dursun Kirbas b, Gulsen A. Demır a. a Istanbul Bilim University, Department of Neurology, Istanbul, Turkey; b Bakirkoy Prof. Dr. Mazhar Osman Teaching And Research Hospital, Department of Neurology, Istanbul, Turkey
Objectives. Early-onset dementia is defined as dementia before 65 years
of age. The prevalence of dementia <65 years of age is approximately 54260/100,000. Studies on early onset Alzheimer’s dementia (AD) show different clinical and sociodemographic features compared to late onset AD. We aimed to study the clinical and sociodemographic features of early onset AD patients in our department.
Murat Emre. University of Istanbul, Faculty of Medicine, Department of Neurology, Istanbul, Turkey
In contrast to the classical perception of Parkinson’s disease (PD) mainly as a motor disorder, cognitive impairment and dementia has been increasingly more recognized as associated features of PD over the last few decades. Subtle cognitive deficits are found in most studies comparing PD patients with normal controls, also in those conducted in newly diagnosed patiens. The incidence of dementia is susbtantially increased in patients with PD, 4-6 times higher rates than controls and point-prevalence of approximately 30% have been reported. The main risk factors are old age and the akinetic-rigid form of the disease. Presence of subtle deficits in executive functions, verbal fluency, and early development of psychosis on dopaminergic medication are also risk factors for incipient dementia. The typical cognitive profile of dementia in PD is a dysexecutive syndrome with impaired and fluctuating attention, apathy, prominent impairment of executive and visuo-spatial functions. Memory impairment is frequent, but it is usually different than that seen in Alzheimer’s disease with impaired free recall, but relatively better recognition. Core language functions are largely preserved except for reduced verbal fluency and anomia. Personality changes and behavioral symptoms such as hallucinations are frequent. The assessment and diagnosis of dementia in PD involves two steps. First, dementia syndrome should be differentiated from conditions which can mimic dementia, such as depression and confusion. Once the presence of dementia syndrome is ascertained the second step involves differential diagnosis in order to exclude other disorders with combined dementia and parkinsonism. The most consistent neurotransmitter deficit associated with PDD is cholinergic, clinical trials using cholinesterase inhibitors (ChE-I) have been conducted. A number of small studies with different ChE-I and large randomized, placebo controlled trials with rivastigmine and donepezil revealed that ChE-I can be beneficial in PDD patients, rivastigmine has been approved as the first treatment for PDD.
THE EFFECTS OF SYMPTOMS AND MEDICATION ON WORKING MEMORY IN PARKINSONISM Ahmed H. Mostafa a, Peter Bell a, Doaa H. Hewedi b, Abeer M. Eissa b. a University of Western Sydney, School of Social Sciences and Psychology, Sydney, Australia; b Ain Shams University, Faculty of Medicine, Department of Psychogeriatrics