- Email: [email protected]
How many tests are required for diagnosis of memory impairment?
P452
Poster Presentations P4
used longitudinally. However, it does not appear that the TICS is sensitive in distinguishing more mild or moderate levels of cognitive impairment.
P4-070
FALSE RECOGNITION IN ALZHEIMER’S DISEASE AND MILD COGNITIVE IMPAIRMENT
Reiko Koide1, K. Ishii2, Hikari Kinjo3, T. Takeda2, Y. Tomidokoro2, A. Tamaoka2, 1Department of Neurology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-Shi, Ibaraki-Ken, Japan; 2University of Tsukuba, Tsukuba-Schi, Ibaraki-Ken, Japan; 3School of Social Information Studies, Otsuma Women’s University, Tokyo, Japan. Contact e-mail: [email protected] Background: False Recognition, usually called False Alarm (FA), is a common type of memory distortions in which an individual incorrectly claims to have encountered a novel object or event. Although the hippocampus has been shown to be the responsible brain region, few studies have reported its clinical manifestation in the progression of Alzheimer’s disease (AD). We analyzed the data on FA responses in the word recognition task in Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-Cog) in patients with AD, with mild cognitive impairments (MCI), and normal controls. Methods: The data of 28 patients with probable AD, 28 patients with MCI, and 58 age-matched controls, were analyzed. AD was diagnosed according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer’s Disease and Related Disorders Association (ADRDA). Patients with MCI were diagnosed on the basis of showing intact daily activity, normal Mini-Mental State Examination (MMSE, 30-25), and deviated memory reduction (less than 85) in at least one index of Wechsler Memory Scale Revised (WMS-R). MRI and SPECT were administered to MCI patients. They showed reduced cerebral perfusion in the right or left hippocampus, or in bilateral parietal lobes and posterior or anterior cingular gyrus. One of them showed slight lacuna infarctions, though applied to the above criteria. Normal control subjects were attending a municipal physical fitness program for senior citizens. All of them showed normal MMSE (28-30), and normal memory scores in all WMS-R indexes. Results: FA was observed in patients with AD more frequently than patients with MCI and normal controls at a statistically significant level (p<0.000). No statistically significant difference was found between the groups of MCI and controls. FA was observed in 27 out of 28 AD patients, but with one exception, none was observed in MCI or in normal controls. Conclusions: The presence of FA in the word recognition test of ADASCog could be used as one of the markers to detect the onset of AD in the progression of the disease from MCI to AD, although it was not sensitive to detect its prodromal phase. P4-071
ANALYSIS OF TOP-DOWN CONTROL AND SPATIAL ATTENTION IN MILD COGNITIVE IMPAIRMENT AND ALZHEIMER’S DISEASE: RELATIONSHIP TO APOE4 GENOTYPE
Petra Redel1, Peter Bublak2, Christian Sorg3, Alexander Kurz3, Werner X. Schneider4, Hermann J. Mu¨ller5, Kathrin Finke1, 1Psychology
Department, Neuro-Cognitive Psychology, Ludwig Maximilian University, Munich, Germany; 2Neuropsychology Unit, Neurology Clinic, Friedrich Schiller University, Jena, Germany; 3Clinic and Polyclinic for Psychiatry and Psychotherapy, Technical University, Munich, Germany; 4Psychology Department, Neuro-Cognitive Psychology, Bielefeld University, Bielefeld, Germany; 5Psychology Department, General and Experimental Psychology/Neuro-Cognitive Psychology, Ludwig Maximilian University, Munich, Germany. Contact e-mail: [email protected] Background: Accumulating evidence suggests that deficits of visual selective attention may already occur at early stages of dementia like the prodromal phase of Mild Cognitive Impairment (MCI). Methods: For the attentional assessment in patients with MCI and probable Alzheimer’s disease (AD), we used partial report of brief letter arrays in combination with Bundesen’s theory of visual attention (Bundesen, 1990). On the basis of performance in this task TVA provides two mathematically independent and quantitative parameter estimates: task-related weighting for prioritizing relevant visual objects (top-down control), and the spatial distribution of attentional weights across the left and right hemi-field. Results: Compared to an age-, gender- and education-matched healthy control group, AD patients showed significantly reduced top-down control functions whereas MCI patients were unimpaired. In contrast, spatial attentional weighting was already highly significantly unbalanced across hemifields in MCI. While the majority of patients were lateralized to the left hemifield, a rightward attentional bias was also found in a few patients. In the AD stage the bias was even more pronounced. Controls showed balanced spatial weighting across both hemifields. Analysis of the effects of ApoE4 genotype (positive versus negative) and age (65 years) on spatial attentional weighting in a combined patient group suggests that especially in young, ApoE4-positive patients a pathological leftward spatial bias prevails. For both partial report parameters correlations with clinical criteria like e.g. the Clinical Dementia Rating Scale (CDR; Morris, 1993) rating the overall severity of cognitive deficits and the neurological status according to The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD; Thalmann al., 1997) were found. Conclusions: In conclusion, already the early MCI stage in the neurodegenerative progression to dementia seems to be characterized by pathologically unbiased spatial weighing. At the AD stage, reduced selectivity of topdown control appears to emerge additionally. Probable underlying genetic ApoE4 pathology seems to be related with spatial attention, irrespective of disease stage. Consequently, these results emphasise the necessity of the application of sensitive tools for the assessment of task-related and spatial attentional selection in Alzheimer’s disease. P4-072
HOW MANY TESTS ARE REQUIRED FOR DIAGNOSIS OF MEMORY IMPAIRMENT?
Aynur Ozge1, Kahraman Kiral2, Bahar Tasdelen1, 1Mersin University School of Medicine, Mersin, Turkey; 2Mersin University School of Science and Letters, Mersin, Turkey. Contact e-mail: [email protected] Background: An increased number of elderly in communities may lead to a dementia pandemic. Diagnosis dementia and starting of a pharmacological treatment as early as possible is important, because dementia imposes an emotional and economic burden on the society. Consequently there is an increasing need for efficient cognitive screening instruments to distinguish the elderly with Mild Cognitive Impairment (MCI), who are at risk of developing dementia, from the healthy elderly. This study aims to evaluate individual’s cognitive functional features in a community based system. Methods: In this study, individuals, who are isolated memory impairment complaints and were referred to the Alzheimer Associations Branch in Mersin, Turkey by their consultants, neuropsychological evaluations were made. The individuals were assessed with a neuropsychological test battery including Standardized Mini Mental State Examination Test (MMSE), Geriatric Depression Scale, Functional Activities Questionnaire (FAQ), 3Words3Shapes Test(3W3S), Clockdrawing Test (CDT), Color Trails Test form A-B (CTT 1-2), Verbal Fluency Test (human, animal, human/animal), Visual Verbal Test. Demographic features of individuals were assessed by the same team. Results: A total of 50 subject were included in the study; 60 % of patients were female (mean age; 58.2) and 40 % of patients were male (mean age; 59.5). There are high
Poster Presentations P4 correlation between MMSE subscores and other tests except GDS. Detailed subscale analysis has been made also. Conclusions: Our findings revealed a need for the development of brief and efficient cognitive screening instruments (at least good applied MMSE and additional one structural or visio-spatial test) that are applicable by professionals other than consultant for diagnosis of Mild Cognitive Impairment (MCI) in community based studies. P4-073
PROCEDURAL SKILL LEARNING IN ALZHEIMER’S DISEASE: GOAL VS. ACTION
Daniel Press, Neechi Mosha, Lisa Iguchi, Daniel Cohen, Edwin Robertson, Beth Israel Deaconess Medical Center, Boston, MA, USA. Contact e-mail: [email protected] Background: One of the earliest signs of Alzheimer’s disease (AD) is a deficit in declarative memory, but procedural learning is often preserved. Recent findings in procedural skill learning suggest that like declarative memory, procedural learning has different components. One aspect of a skill is action-based, tied to specific effectors, and learned in body space. The other is goal-based, effector-independent and learned in an extra-personal spatial framework. Each is subserved by distinct neural systems. Methods: We measured procedural skill learning in patients with mild AD and demographically-matched controls using the Serial Reaction Time Task, a sequence learning task. After skill was acquired in their right, dominant hand, the participants performed the task in their contralateral hand either where the action, the sequence of finger movements, or where the goal, the sequence of stimuli on the screen, was maintained. Skill was defined as the shortening of reaction times during a block of a repeating 10-item sequence, as compared to a block of pseudo-random trials that followed. Different 10-item sequences were used for the goal and the action trials, with the order of tasks counterbalanced. Results: Preliminary results from Alzheimer’s participants (n¼7) and controls (n¼9) demonstrate that AD participants do acquire a significant degree of skill in the SRTT (81 msec). Controls acquire similar skill (57 msec). While controls acquire roughly equal degrees of action-based skill (113 msec) and goal-based skill (123 msec), AD participants acquire more action-based skill (113 msec) than goal-based skill (70 msec), albeit non-significantly. Conclusions: While most AD participants with mild disease are capable of acquiring skill on a procedural, motor-sequence learning task, their profile of skill acquisition differs from demographically-matched controls. AD participants show a relative impairment in acquisition of goalbased skill, with relative preservation of action-based skill. The findings have implications for how AD patients remediate memory deficits and acquire new skills. P4-074
CORRELATION OF SMC AND OCI IN DEMENTIA SCREENING IN URBAN COMMUNITY: YANGCHEON-GU IN SEOUL
Seungah Go, Ewha Womans University, Mokdong Hospital, Seoul, Republic of Korea. Contact e-mail: [email protected] Background: As the numbers of old man are increasing gradually, the importance of screening for dementia and cognitive impairment becoming increasingly issued. Community based studies showed that subjective memory complaints are quite common among the elderly population. The objects of this study is as follows. 1) The relation between subject memory complaints(SMC) and objective cognitive impairment(OCI), 2) Prevalence of dementia associated risk factors in elderly population of Yangcheon-gu. Methods: A total 465 subjects in Yangcheon-ku, seoul were screened from September 2006 to November 2007 for 6 times period. We evaluated demographic factors (age, sex, education level, occupation), risk factors (hypertension, diabetes, heart disease, hyperlipidemia, previous head trauma and stroke, family history, smoking, alcohol intake), cognitive function (KDSQ, KMMSE), neurologic examination, HIS, GDeps, ADL, three questions for subject memory. We analyzed data to 425 subjects over the age of 65 years. Results: In 425 subjects, 164 subjects answered to three questions for subject memory. 129 subjects(78.7%) were subject memory complaints; score 1(22,13.4%), score 2(74,45%) and score 3(33,20.1%). But objective memory impairment were 50(30.5%). Total score of three questions and each question correlated to K-DSQ(p<0.01). Total score of three
P453
questions correlated to objective memory impairment by KMMSE(P<0.05). In 425 subjects, 91 subjects were male(21.4%) and 344 subjects were female(78.6%). Total mean age was 75.466. Mean Education levels was 5.164.8. Mean KDSQ was 5.864.4. Mean KMMSE was 23.564.8. Mean HIS was 3.663. Mean GDeps was 5.564.2. Incidence of risk factors were hypertension (160,37.7%), diabetes (50,11.8%), hyperlipidemia (22,5.2%), previous stroke (31,7.3%), heart disease (23,5.4%), previous head trauma (5,1.2%), depression (34,8%), previous cancer (15,3.5%), thyroid disease (5,1.2%), family history (12,2.8%), smoking (15,3.5%), alcohol intake (21,4.9%). 3QM showed significant correlation with KDSQ, KMMSE recall and GepS. 78.5 percent (128) of total subjects had subjective memory complaints . 30.7 percent(50) of total subjects had objective cognitive impairment. Mean of 3QFM total score showed statistically significant difference between OCI and non-OCI. (p-value<0.05). Conclusions: Self reported subject memory complaints were most correlated with conventional dementia screening battery. We suggest that self reported subject memory complaints combine with K-DSQ and K-MMSE could be a good screening aid measure for large community dementia screening. P4-075
RIGHT HEMISPHERIC LESIONS MAY AFFECT OVER SELF-ESTIMATION OF DAILY ACTIVITIES IN PATIENTS WITH VASCULAR DEMENTIA
Kimihiro Tezuka, Kenichi Meguro, Naofumi Tanaka, Kyoko Akanuma, Department of Geriatric Behavioral Neurology, Sendai, Japan. Contact e-mail: [email protected] Background: Patients with cerebrovascular diseases showed a decreased level of daily activities and had a risk of falling. This is probably due to impaired self awareness of their daily performances; they overestimated their ability to perform various tasks of daily living. We herein investigated whether self-estimation of ability to perform daily activities was related to cognitive disturbance or the location of brain lesion in patients with vascular dementia (VaD). Methods: The patients with right hemispheric lesions (n¼4) showed larger SBI-BI differences than those with left hemispheric lesions (n¼3). The differences were not correlated with the MMSE scores. One patient (F) showed anosognosia of his left hemiparesis. Results: The patients with right hemispheric lesions showed larger SBI-BI differences than those with left hemispheric lesions. The differences were not correlated with the MMSE scores. One patient (F) showed anosognosia of his left hemiparesis. Conclusions: Patients with right hemispheric lesions showed over-estimation of their own daily activities independent of general cognitive impairment. This may be related to their tendency to fall in a nursing home. P4-076
SYMPTOMS OF APATHY AND DEPRESSION AND THE VALIDITY OF THE AUDIO RECORDED COGNITIVE SCREEN (ARCS)
Peter W. Schofield1,2, Stephen J. Lee1, Grant Lyall2, 1University of Newcastle, Newcastle, Australia; 2Neuropsychiatry Service, Hunter New England Health, Newcastle, Australia. Contact e-mail: peter.schofield@ hnehealth.nsw.gov.au Background: The Audio Recorded Cognitive Screen (ARCS) is an instrument we have developed in which neuropsychological tests are presented to unsupervised patients by way of a simple audio device. Patients respond to the material presented by writing in a booklet that can be later scored. We have validated component tests of the ARCS against comparable tests administered conventionally. Until now, we have not investigated the impact of apathy or depression on validity of the ARCS. It is plausible that patients with these problems might fail to give as much effort when unsupervised (i.e. during the ARCS) as they do when neuropsychological tests are administered by a clinician, threatening the validity of testing. The current study investigates this question. Methods: Patients attending our Neuropsychiatry Service outpatients department were administered the ARCS, a formal battery of neuropsychological tests, the Depression Anxiety Stress Scale (DASS21) and the patient version of the Apathy Evaluation Scale (AES). Diagnoses of dementia, cognitive impairment, or no impairment were made on the basis
Poster Presentations P4
used longitudinally. However, it does not appear that the TICS is sensitive in distinguishing more mild or moderate levels of cognitive impairment.
P4-070
FALSE RECOGNITION IN ALZHEIMER’S DISEASE AND MILD COGNITIVE IMPAIRMENT
Reiko Koide1, K. Ishii2, Hikari Kinjo3, T. Takeda2, Y. Tomidokoro2, A. Tamaoka2, 1Department of Neurology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-Shi, Ibaraki-Ken, Japan; 2University of Tsukuba, Tsukuba-Schi, Ibaraki-Ken, Japan; 3School of Social Information Studies, Otsuma Women’s University, Tokyo, Japan. Contact e-mail: [email protected] Background: False Recognition, usually called False Alarm (FA), is a common type of memory distortions in which an individual incorrectly claims to have encountered a novel object or event. Although the hippocampus has been shown to be the responsible brain region, few studies have reported its clinical manifestation in the progression of Alzheimer’s disease (AD). We analyzed the data on FA responses in the word recognition task in Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-Cog) in patients with AD, with mild cognitive impairments (MCI), and normal controls. Methods: The data of 28 patients with probable AD, 28 patients with MCI, and 58 age-matched controls, were analyzed. AD was diagnosed according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer’s Disease and Related Disorders Association (ADRDA). Patients with MCI were diagnosed on the basis of showing intact daily activity, normal Mini-Mental State Examination (MMSE, 30-25), and deviated memory reduction (less than 85) in at least one index of Wechsler Memory Scale Revised (WMS-R). MRI and SPECT were administered to MCI patients. They showed reduced cerebral perfusion in the right or left hippocampus, or in bilateral parietal lobes and posterior or anterior cingular gyrus. One of them showed slight lacuna infarctions, though applied to the above criteria. Normal control subjects were attending a municipal physical fitness program for senior citizens. All of them showed normal MMSE (28-30), and normal memory scores in all WMS-R indexes. Results: FA was observed in patients with AD more frequently than patients with MCI and normal controls at a statistically significant level (p<0.000). No statistically significant difference was found between the groups of MCI and controls. FA was observed in 27 out of 28 AD patients, but with one exception, none was observed in MCI or in normal controls. Conclusions: The presence of FA in the word recognition test of ADASCog could be used as one of the markers to detect the onset of AD in the progression of the disease from MCI to AD, although it was not sensitive to detect its prodromal phase. P4-071
ANALYSIS OF TOP-DOWN CONTROL AND SPATIAL ATTENTION IN MILD COGNITIVE IMPAIRMENT AND ALZHEIMER’S DISEASE: RELATIONSHIP TO APOE4 GENOTYPE
Petra Redel1, Peter Bublak2, Christian Sorg3, Alexander Kurz3, Werner X. Schneider4, Hermann J. Mu¨ller5, Kathrin Finke1, 1Psychology
Department, Neuro-Cognitive Psychology, Ludwig Maximilian University, Munich, Germany; 2Neuropsychology Unit, Neurology Clinic, Friedrich Schiller University, Jena, Germany; 3Clinic and Polyclinic for Psychiatry and Psychotherapy, Technical University, Munich, Germany; 4Psychology Department, Neuro-Cognitive Psychology, Bielefeld University, Bielefeld, Germany; 5Psychology Department, General and Experimental Psychology/Neuro-Cognitive Psychology, Ludwig Maximilian University, Munich, Germany. Contact e-mail: [email protected] Background: Accumulating evidence suggests that deficits of visual selective attention may already occur at early stages of dementia like the prodromal phase of Mild Cognitive Impairment (MCI). Methods: For the attentional assessment in patients with MCI and probable Alzheimer’s disease (AD), we used partial report of brief letter arrays in combination with Bundesen’s theory of visual attention (Bundesen, 1990). On the basis of performance in this task TVA provides two mathematically independent and quantitative parameter estimates: task-related weighting for prioritizing relevant visual objects (top-down control), and the spatial distribution of attentional weights across the left and right hemi-field. Results: Compared to an age-, gender- and education-matched healthy control group, AD patients showed significantly reduced top-down control functions whereas MCI patients were unimpaired. In contrast, spatial attentional weighting was already highly significantly unbalanced across hemifields in MCI. While the majority of patients were lateralized to the left hemifield, a rightward attentional bias was also found in a few patients. In the AD stage the bias was even more pronounced. Controls showed balanced spatial weighting across both hemifields. Analysis of the effects of ApoE4 genotype (positive versus negative) and age (65 years) on spatial attentional weighting in a combined patient group suggests that especially in young, ApoE4-positive patients a pathological leftward spatial bias prevails. For both partial report parameters correlations with clinical criteria like e.g. the Clinical Dementia Rating Scale (CDR; Morris, 1993) rating the overall severity of cognitive deficits and the neurological status according to The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD; Thalmann al., 1997) were found. Conclusions: In conclusion, already the early MCI stage in the neurodegenerative progression to dementia seems to be characterized by pathologically unbiased spatial weighing. At the AD stage, reduced selectivity of topdown control appears to emerge additionally. Probable underlying genetic ApoE4 pathology seems to be related with spatial attention, irrespective of disease stage. Consequently, these results emphasise the necessity of the application of sensitive tools for the assessment of task-related and spatial attentional selection in Alzheimer’s disease. P4-072
HOW MANY TESTS ARE REQUIRED FOR DIAGNOSIS OF MEMORY IMPAIRMENT?
Aynur Ozge1, Kahraman Kiral2, Bahar Tasdelen1, 1Mersin University School of Medicine, Mersin, Turkey; 2Mersin University School of Science and Letters, Mersin, Turkey. Contact e-mail: [email protected] Background: An increased number of elderly in communities may lead to a dementia pandemic. Diagnosis dementia and starting of a pharmacological treatment as early as possible is important, because dementia imposes an emotional and economic burden on the society. Consequently there is an increasing need for efficient cognitive screening instruments to distinguish the elderly with Mild Cognitive Impairment (MCI), who are at risk of developing dementia, from the healthy elderly. This study aims to evaluate individual’s cognitive functional features in a community based system. Methods: In this study, individuals, who are isolated memory impairment complaints and were referred to the Alzheimer Associations Branch in Mersin, Turkey by their consultants, neuropsychological evaluations were made. The individuals were assessed with a neuropsychological test battery including Standardized Mini Mental State Examination Test (MMSE), Geriatric Depression Scale, Functional Activities Questionnaire (FAQ), 3Words3Shapes Test(3W3S), Clockdrawing Test (CDT), Color Trails Test form A-B (CTT 1-2), Verbal Fluency Test (human, animal, human/animal), Visual Verbal Test. Demographic features of individuals were assessed by the same team. Results: A total of 50 subject were included in the study; 60 % of patients were female (mean age; 58.2) and 40 % of patients were male (mean age; 59.5). There are high
Poster Presentations P4 correlation between MMSE subscores and other tests except GDS. Detailed subscale analysis has been made also. Conclusions: Our findings revealed a need for the development of brief and efficient cognitive screening instruments (at least good applied MMSE and additional one structural or visio-spatial test) that are applicable by professionals other than consultant for diagnosis of Mild Cognitive Impairment (MCI) in community based studies. P4-073
PROCEDURAL SKILL LEARNING IN ALZHEIMER’S DISEASE: GOAL VS. ACTION
Daniel Press, Neechi Mosha, Lisa Iguchi, Daniel Cohen, Edwin Robertson, Beth Israel Deaconess Medical Center, Boston, MA, USA. Contact e-mail: [email protected] Background: One of the earliest signs of Alzheimer’s disease (AD) is a deficit in declarative memory, but procedural learning is often preserved. Recent findings in procedural skill learning suggest that like declarative memory, procedural learning has different components. One aspect of a skill is action-based, tied to specific effectors, and learned in body space. The other is goal-based, effector-independent and learned in an extra-personal spatial framework. Each is subserved by distinct neural systems. Methods: We measured procedural skill learning in patients with mild AD and demographically-matched controls using the Serial Reaction Time Task, a sequence learning task. After skill was acquired in their right, dominant hand, the participants performed the task in their contralateral hand either where the action, the sequence of finger movements, or where the goal, the sequence of stimuli on the screen, was maintained. Skill was defined as the shortening of reaction times during a block of a repeating 10-item sequence, as compared to a block of pseudo-random trials that followed. Different 10-item sequences were used for the goal and the action trials, with the order of tasks counterbalanced. Results: Preliminary results from Alzheimer’s participants (n¼7) and controls (n¼9) demonstrate that AD participants do acquire a significant degree of skill in the SRTT (81 msec). Controls acquire similar skill (57 msec). While controls acquire roughly equal degrees of action-based skill (113 msec) and goal-based skill (123 msec), AD participants acquire more action-based skill (113 msec) than goal-based skill (70 msec), albeit non-significantly. Conclusions: While most AD participants with mild disease are capable of acquiring skill on a procedural, motor-sequence learning task, their profile of skill acquisition differs from demographically-matched controls. AD participants show a relative impairment in acquisition of goalbased skill, with relative preservation of action-based skill. The findings have implications for how AD patients remediate memory deficits and acquire new skills. P4-074
CORRELATION OF SMC AND OCI IN DEMENTIA SCREENING IN URBAN COMMUNITY: YANGCHEON-GU IN SEOUL
Seungah Go, Ewha Womans University, Mokdong Hospital, Seoul, Republic of Korea. Contact e-mail: [email protected] Background: As the numbers of old man are increasing gradually, the importance of screening for dementia and cognitive impairment becoming increasingly issued. Community based studies showed that subjective memory complaints are quite common among the elderly population. The objects of this study is as follows. 1) The relation between subject memory complaints(SMC) and objective cognitive impairment(OCI), 2) Prevalence of dementia associated risk factors in elderly population of Yangcheon-gu. Methods: A total 465 subjects in Yangcheon-ku, seoul were screened from September 2006 to November 2007 for 6 times period. We evaluated demographic factors (age, sex, education level, occupation), risk factors (hypertension, diabetes, heart disease, hyperlipidemia, previous head trauma and stroke, family history, smoking, alcohol intake), cognitive function (KDSQ, KMMSE), neurologic examination, HIS, GDeps, ADL, three questions for subject memory. We analyzed data to 425 subjects over the age of 65 years. Results: In 425 subjects, 164 subjects answered to three questions for subject memory. 129 subjects(78.7%) were subject memory complaints; score 1(22,13.4%), score 2(74,45%) and score 3(33,20.1%). But objective memory impairment were 50(30.5%). Total score of three questions and each question correlated to K-DSQ(p<0.01). Total score of three
P453
questions correlated to objective memory impairment by KMMSE(P<0.05). In 425 subjects, 91 subjects were male(21.4%) and 344 subjects were female(78.6%). Total mean age was 75.466. Mean Education levels was 5.164.8. Mean KDSQ was 5.864.4. Mean KMMSE was 23.564.8. Mean HIS was 3.663. Mean GDeps was 5.564.2. Incidence of risk factors were hypertension (160,37.7%), diabetes (50,11.8%), hyperlipidemia (22,5.2%), previous stroke (31,7.3%), heart disease (23,5.4%), previous head trauma (5,1.2%), depression (34,8%), previous cancer (15,3.5%), thyroid disease (5,1.2%), family history (12,2.8%), smoking (15,3.5%), alcohol intake (21,4.9%). 3QM showed significant correlation with KDSQ, KMMSE recall and GepS. 78.5 percent (128) of total subjects had subjective memory complaints . 30.7 percent(50) of total subjects had objective cognitive impairment. Mean of 3QFM total score showed statistically significant difference between OCI and non-OCI. (p-value<0.05). Conclusions: Self reported subject memory complaints were most correlated with conventional dementia screening battery. We suggest that self reported subject memory complaints combine with K-DSQ and K-MMSE could be a good screening aid measure for large community dementia screening. P4-075
RIGHT HEMISPHERIC LESIONS MAY AFFECT OVER SELF-ESTIMATION OF DAILY ACTIVITIES IN PATIENTS WITH VASCULAR DEMENTIA
Kimihiro Tezuka, Kenichi Meguro, Naofumi Tanaka, Kyoko Akanuma, Department of Geriatric Behavioral Neurology, Sendai, Japan. Contact e-mail: [email protected] Background: Patients with cerebrovascular diseases showed a decreased level of daily activities and had a risk of falling. This is probably due to impaired self awareness of their daily performances; they overestimated their ability to perform various tasks of daily living. We herein investigated whether self-estimation of ability to perform daily activities was related to cognitive disturbance or the location of brain lesion in patients with vascular dementia (VaD). Methods: The patients with right hemispheric lesions (n¼4) showed larger SBI-BI differences than those with left hemispheric lesions (n¼3). The differences were not correlated with the MMSE scores. One patient (F) showed anosognosia of his left hemiparesis. Results: The patients with right hemispheric lesions showed larger SBI-BI differences than those with left hemispheric lesions. The differences were not correlated with the MMSE scores. One patient (F) showed anosognosia of his left hemiparesis. Conclusions: Patients with right hemispheric lesions showed over-estimation of their own daily activities independent of general cognitive impairment. This may be related to their tendency to fall in a nursing home. P4-076
SYMPTOMS OF APATHY AND DEPRESSION AND THE VALIDITY OF THE AUDIO RECORDED COGNITIVE SCREEN (ARCS)
Peter W. Schofield1,2, Stephen J. Lee1, Grant Lyall2, 1University of Newcastle, Newcastle, Australia; 2Neuropsychiatry Service, Hunter New England Health, Newcastle, Australia. Contact e-mail: peter.schofield@ hnehealth.nsw.gov.au Background: The Audio Recorded Cognitive Screen (ARCS) is an instrument we have developed in which neuropsychological tests are presented to unsupervised patients by way of a simple audio device. Patients respond to the material presented by writing in a booklet that can be later scored. We have validated component tests of the ARCS against comparable tests administered conventionally. Until now, we have not investigated the impact of apathy or depression on validity of the ARCS. It is plausible that patients with these problems might fail to give as much effort when unsupervised (i.e. during the ARCS) as they do when neuropsychological tests are administered by a clinician, threatening the validity of testing. The current study investigates this question. Methods: Patients attending our Neuropsychiatry Service outpatients department were administered the ARCS, a formal battery of neuropsychological tests, the Depression Anxiety Stress Scale (DASS21) and the patient version of the Apathy Evaluation Scale (AES). Diagnoses of dementia, cognitive impairment, or no impairment were made on the basis