Functional - cognitive assessment scale a new scale to predict early dementia and follow up

Poster Presentation:

Clinical Research IV

S235

cognitive decline and contributed toearly disabilities compared to those whom did not present this symptom. I also wish to encourage further research in this area.

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FUNCTIONAL - COGNITIVE ASSESSMENT SCALE A NEW SCALE TO PREDICT EARLY DEMENTIA AND FOLLOW UP

Magdu

Ch Tsolaki,

Kmnti,

Aristldes

Arisfotle

D Kazis,

Univ

uf Thessuloniki,

Anastasi~r

J Euklides,

Thessaloniki

Aristotle

Greece;

Univ,

Fotini

Thessaloniki

Ch

Greece

The Functional -Cognitive Assessment Scale, (FUCAS) has been created in order to examine the executive functional performance of demented persons in a direct objective manner. Fucas assesses functionality through six important activities of every day life: drug taking, economics, clothing, washing, orientation, communication. Performance is not affected by education or age. Fucas structure is based on the precondition that : a)all of the above mentioned activities of everyday life, demand a cognitive background, and b) execution of these activities follows the cognitive process of problem solving Performance evaluation is achieved following the stages of problem solving procers: a) problem s detection b) solving organization and planning c) execution with solution appliance. As we notice patient 3 functional behaviors, we evaluate the cognitive functions preexisting behind them and we get his cognitive profile. Besides, the functional impairment from a premorbid level, that is caused by a respective cognitive-mnemonic impairment, is one of the most significant criterta for dementia according to DSM-IV. As soon as the standardization of Fucas was accomplished, the new scale has been proved to be: a) much more sensitive, than the commonly used functional tests (FRSSD) b) undoubtedly objective c) able to discriminate the fine mnemonic, cognitive and functional change?, during follow-up that are not recognized by other tests d) able to diagnose dementia, when combined with a certain battery of tests e) able to predict dementia, in very early stage, since it gives us planning assessment, a significant index of possible Alzheimer’s disease.

DEPRESSION IN PERSONS WITH DEMENTIA IN THE FIRST YEAR AFTER ADMISSION TO A LONG TERM CARE FACHJTY Jmni&

L Puyne.

Marie

E Sheppard,

Swsle.

The Johns

Hopkim

Sch ,f

Medicine,

MD:

Cmmantke

S\kr.n~ille.

Thr

Johns

H<)pkins

.l<~h,hnsHopkins Hopkins

Sch

ofMedicine.

Sch of Medicine,

Sch of Medicine. Baltimore, G Lyketsos.

MD:

Baltimore, Alvo

Baltimnre, Baltimore, MD:

S Baker,

The Copper

MD; MD;

Jason

Copper

Ridge Institute,

JeannirCynthia

Brandt, Ridge

D

Johns

Institutr,

SFkr.5 villr.

MD

We present the results of a study of depresston in resident\ with dementia at Copper Ridge, a long term care facihty for the memory impaIred, with both assl\ted living and skilled nursing levels of care. The prevalence, incidence, recurrence, persistence. and annual attack rate5 for moderate-severe depressive features (“depression”), as defined by the Cornell Scale for Depression in Dementia (CSDD), were estimated for 201 residents with dementia, of whom 120 had probable Alrhaimer’a disease. Resident\ were followed every ?ix months during the first year after their admirsion. No such e\tlmates have been published previously. On admission 19.9% of the residents had depression, the majority (75%) occurring in persons with a prior history of depression. At six month?, only 15% of the original 40 depressed patients were still depressed, while at twelve months only 7.5% were depressed. The incidence of depression (new depression in those with no history of depression) at six and twelve months was 1.8% and 6.4% respectively. Most persona with new depression at six months were no longer depressed at one year. The annual attack rate (cumulative likelihood of depnxmn over one year) for the total population was 26.4%. The rate\ for the cubgroup of residents with Alzheimer’? disease were similar to the rate7 for the total population. except for an annual attack rate of 17.570, mostly due to a lower rate of depression ox admission. The dechne in depresrion over the year after admission I\ noteworthy and may reflect appropriate diagnosis and treatment of depression. Alternatively, the highly qupportivr and structured environment of Copper Ridge may \erve to reduce depression. These results indicate that. over a year’s time, deprecrion afflicts a considerable proportion of long-term care residents with dementia. Admihsion to a long-term care fauhty, such a~ Copper Ridge, may actually rerult in a reduction of depression within the year after admiaaion in part due to rapid recognition. appropriate diagnosis and treatment.

EFFECT OF A COMPREHENSIVE 110741 FUNCTION IN NURSING HOME

EXERCISE PROGRAM ON RESIDENTS WITH ALZHEI-

MER’S DISEASE Ruth M Tappen, Mimii,

Coral

Florida

Gables,

Atluntic FL:

The’s

Univ.

Bocu Raton,

A Touhy,

Florida

FL:

Kuthryn

Atlantic

Univ.

E Roach,

Univ

Bacu Ratw

of FL

The progressive functional decline of Alzheimer’? Disease (AD) ia well documented but few interventions to improve function have been found to be efficacious in clinical \rttinga. In this ongoing study. a three-group repeated measures design with randomired araignment to treatment group and raters blinded to treatment group

assignment is being utilized to test the effectiveness of a comprehensive exercise routine designed to build strength, flexibility, balance and endurance in nursing home residents with Alzheimer’s disease. This treatment is being compared with a supervised walking program and attention control which consists of social conversation for the same amount of time as the exercise program. All subjects receive treatment 5 times a week for 30 minutes per session. The mean age of this sample is 87; their mean Mini-Mental State Examination score is 7.21 with a range of 0 to 23; 85% are female. All were prescreened for a clinical diagnosis of probable AD using NINCDS-ADRDA criteria. The Physical Self-Maintenance Scale and Six Minute Walk are being used to evaluate ADL function and physical performance capacity, respectively. Analysis of covtiatxe controlling for baseline scores indicates a significant difference across group on the Physical Self-Maintenance Scale (F = 5.02, p i .02). At posttest the gr~gup receiving the exercise treatment were found to have improved while the walking group maintained their pretest level of ability to perform the basic activities of daily living and the attention control group’s ability declined. Similarly, the exercise group evidenced a higher mean distance walked in 6 minutes at postteat than they had at pretest while the walking group maintained their level of function and the attention control group declined significantly (F = 3.90, p = < 04). This intervention can be readily taught to assistive and technical level staff. These preliminary findings suggest that the exercise interventions could represent a clinically significant advance over the present walking programs commonly used with thlr population.

A STUDY ON THE CATABOLISM AND FUNCTION TYPE AND MUTATED a-SYNUCLEINS Cristirw

AIves

du Costa,

OF WILD-

AK

Synucleins are neuronal proteins detectable in the nemopathological lesions of several cerebral disorders including Parkinson and Abheimer’s diseases. ol-synuclein is a 140 amino-acids protein which was originally identified as the precursor of the nonAPcomponent of Alzheimer‘s disease amyloid (NACP). a-synuclein immunoreactivIty 1s also found in Lewy bodies, the ixstopathological hallmark of sporadic Parkinson disease-affected brains. When mutated, a-synuclein seems to be responsible for some familial forma of Parkinson disease. As Lewy bodies are enriched in ubiquitinated structures and alro contain proteasome-related immunoreactivity. it could be hypothetlrrd that the proteasome contributes to the cellular degradation of Lu-synucleins, thereby controlling their concentration-dependent aggregation process. Here, we first demonstrate that u-synuclein i\ notubiquitinated in HEK293 cells. Furthermore, by means of two specific inhibitor\, we show that wild type and Ala53Thr u-synuclein do not behave as proteasome substrates in HEK293 cells and marine neurons. Our study mdicatrs that the proteasome doca not contribute to the confrol of cellular \ynucleins concentration and therefore. unlikely participate\ to cerebral a-?ynucleinopathiea. We also report here on a phenotypic alteration triggered by the muttaion of \ynuclein in neuronal cells.

SOME CHARACTERISTICS ALZHEIMER’S DISEASE

OF EARLY AND LATE FORMS OF

Ohjectivca: Alrheimer‘h Disease (AD) manifests mostly in mlddle age. However, the prevznce of so called early or .juvenile, as well as late (senile) and less progredient form? of the mentioned disease shows, that it 15 not always justified the classification of AD as the one. leadmg to xvere cognitive impairment in presemle age. Methods: In order to study chmcal characteristics of the mentioned above form?, of AD, we conducted chnical and neurological mvestipatlon of 17 patients (IO females and 7 male\), with the mamfestation of disease at age 3X-44 and of 30 patients (21 females and 9 males) with manifestation of AD at the age of 65-83. Results: All the patient\ showed the mamfe+tation of AD by the symptoms of progressing amnesia. In the late \lage ot disease there I\ a total disintegration of cognitive functioning, total aphasia and apraxia. 22 patients also rhowed epileptiform fits. Our study showed, that early forms of AD often manifest with tactile (haptic and hygric) hallucinations, IocaliLed in genitals. and with genital hallucinations with erotic content. The pathologic proce\\ proceeds by two phase\: psychotic phase with duration until 5 years and phase of total dementia with duration from 8 to IS years. In a case of late forms of AD, the illness manifest\ with visual and tactile hallucinosia or with ecmneatic confabulations, accompanied by delusion, of jealousy. These lmtial psychotic disturbance\ last from 5 to 10 year?, and only after long lasting initial period, features of total. dementia become evident. The symptoms and signs of dementia mostly manifest in the presence of exacerbated infections or cardiovascular diseases. In patient with late onset of AD. there wa\ no preceding exogenous factors or somatic illnesses. Conclusions: Beside\ clarsical form? of AD, thrre should be diqtmguished its early and late forms. which have qmte pathognomomc features. However, in both case\ of AD. irrespective of initial period, the late stage5 of the mentioned pathology has similar character, which proves the fact of nosologlcal independents of AD Eden m different type\ of its courts of duration.