Improving diagnosis of dementia in a nationwide setting: First results of the Dutch String of Pearls Initiative on neurodegenerative diseases

Poster Presentations: P2 Table 2 Comparison of baseline characteristics between men and women completed follow up Men(n¼92)

PWomen (n¼187) value

Total Cholesterol, mean (SD) 175.36 (30.74) 197.88 (38.16) Triglyceride, mean (SD) 193.41 (172.27) 189.97 (129.65) HDL, mean (SD) 54.97 (50.56) 49.72 (12.66) LDL, mean (SD) 97.77 (26.72) 115.45 (29.47) APOE genotype, mean (SD) 3.87 (0.77) 3.84 (0.81) Height, mean (SD) 162.62 (7.12) 148.59 (6.19) Body Weight, mean (SD) 59.30 (9.62) 51.19 (8.81)

0.000 0.852 0.183 0.000 0.785 0.000 0.000

Table 3 Associations between height and other variables including cognitive decline after adjustment of age, gender and education

K-MMSE Difference CDR-G Difference CDR-SB Difference IADL Difference GDS-S Difference

Correlation coefficient

P value

-0.053 -0.075 -0.037 -0.002 0.097

0.392 0.222 0.550 0.980 0.115

Table 4 Associations between Body Weight and other variables including cognitive decline after adjustment of age, gender and education.

K-MMSE Difference CDR-G Difference CDR-SB Difference IADL Difference GDS-S Difference P2-194

Correlation coefficient

P value

-0.018 -0.034 0.013 0.035 0.070

0.769 0.577 0.832 0.575 0.258

IMPROVING DIAGNOSIS OF DEMENTIA IN A NATIONWIDE SETTING: FIRST RESULTS OF THE DUTCH STRING OF PEARLS INITIATIVE ON NEURODEGENERATIVE DISEASES

Pauline Aalten1, Wiesje Van der Flier2, Geert Jan Biessels3, Nico Leenders4, Marcel Olde-Rikkert5, Ania Oleksik6, Edo Richard7, John van Swieten8, Inez Ramakers9, H. Koek10, Frans R.J. Verhey11, Philip Scheltens12, 1MUMC, Maastricht, Netherlands; 2VU University Medical Center, Amsterdam, Netherlands; 3UMC Utrecht, Utrecht, Netherlands; 4University Medical Center Groningen, Groningen, Netherlands; 5University Medical Center Nijmegen, Nijmegen, Netherlands; 6Leiden University Medical Center, Leiden, Netherlands; 7 Academic Medical Center, Amsterdam, Amsterdam, Netherlands; 8 Erasmus Medical Center, Roterdam, Netherlands; 9Maastricht University Medical Center, Maastricht, Netherlands; 10University Medical Center Utrecht, Utrecht, Netherlands; 11Alzheimer Center Limburg, Maastricht, Netherlands; 12Alzheimer Center Amsterdam, Amsterdam, Netherlands. Background: The String of Pearls Initiative is a collaboration between 8 Dutch University Medical Centers (UMCs) in which clinical data and biomaterials from patients suffering from chronic diseases (so called "Pearls") are collected according to harmonized protocols. The Pearl Neurodegenerative Diseases (PND) focuses on the role of biomarkers in the early diagnosis and in monitoring the course of neurodegenerative diseases, in particular Alzheimer’s disease (AD). The PND is the first Pearl that has started analyses. The objective of the analyses is to describe the characteristics of the baseline data, including their biomarker profile. These baseline data will form the basis for further research into biomarkers and prognostic factors in dementia. Methods: The PND is a 2-year follow-up study of patients referred to a memory clinic with subjective and/or objective cognitive complaints. At baseline, all patients are subjected to a standardized examination, including the following out-

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come measurements: general information, medical history, MMSE, CDR, Neuropsychiatric Inventory, Geriatric Depression Scale, Disability Assessment for Dementia, Quality of life, a neuropsychological test battery, blood samples, MRI and CSF.Descriptive analyses will be performed on these baseline data, including biomarker profiles of CSF (amyloid beta, tau, ptau), genotyping (APOE) and MRI (white matter lesions, atrophy). Results: Clinical data of all 8 UMCs are being combined in one dataset. Data analyses are ongoing and biomarker profiles are being analyzed. In total 904 patients have been included, of which CSF and DNA samples are available of 261 and 887 patients, respectively. First descriptive of a subsample of the data (n ¼ 288) shows that patients are diagnosed with AD (34%), Mild Cognitive Impairment (22%), subjective memory complaints (24%) and 20% with other dementia. It is expected that all descriptive analyses of the baseline data will be finished in May 2012. Conclusions: The PND is a large network collecting clinical data, MRI, blood and CSF of more than 900 patients with cognitive impairments. The PND is the first that has started with data analyses of the baseline characteristics and biomarkers, which will be the starting point of future specific research questions that can be answered by this unique dataset. P2-196

DIFFERENCES IN DEMENTIA PRESENTATION AMONG ELDERLY ASIANS COMPARED TO NONASIANS

Roger Wong, Jonathan Money, Ging-Yuek Hsiung, University of British Columbia, Vancouver, British Columbia, Canada. Background: Previous studies suggested that Asian patients with dementia presented at a more severe stage than non-Asians. Our study objective was to explore differences in dementia presentation among elderly Asians compared to nonAsians. Methods: We conducted a retrospective chart review of patient visits in 2000-2009 from 2 tertiary referral ambulatory clinics at a major academic health science centre. Data collection included baseline demographics, medical history, and mini-mental state examination (MMSE) scores. Alzheimer’s disease (AD) was diagnosed by DSM-IV criteria and vascular dementia (VaD) by radiological finding of cerebrovascular disease and vascular risk factors plus cognitive syndrome. We compared continuous variables using two-tailed t-tests and discontinuous variables by Pearson chi-square. Results: There were 927 patients (Asians 406, non-Asians 521) diagnosed with dementia with 58.9% females. Most patients were elderly, with 38.0% age 70-79, 31.1% age 80-89 and 3.8% age 90 and above. The Asian patients in this cohort were significantly older than non-Asians (P ¼ 0.00). Vascular risk factors were prevalent in all patients at initial presentation (Asians 73.9%, non-Asians 77.7%, P ¼ 0.17). The most common dementia diagnosis was AD (75.6%), followed by mixed AD/VaD (12.2%), other dementias (8.5%) and VaD (3.6%). There was no gender difference in distribution of dementia types (P ¼ 0.14). Non-AD non-vascular dementias were significantly more prevalent in non-Asians (17.3%) than Asians (4.2%, P ¼ 0.00). Asian dementia patients presented with lower MMSE 18.4 [5.9] (mean [SD]) than non-Asian dementia patients 22.2 [5.8] (P ¼ 0.00) at initial clinic visit, and the difference narrowed by the final visit: Asians 17.7 [6.4], non-Asians 18.7 [7.1] (P ¼ 0.07). In general, Asian patients had fewer clinic visits 3.2 [2.9] than non-Asians 4.2 [3.5] (P ¼ 0.00). Conclusions: In our cohort, Asian patients with dementia presented at an older age, at a more severe stage (lower MMSE), and had fewer follow-up visits to the specialist clinics compared to non-Asians. Further studies are warranted to explore plausible biologic, psychological, social, cultural, economic, or educational determinants of such presentation differences. P2-197

NEUROPROTECTIVE MECHANISMS OF S-ADENOSYLMETHIONINE (SAM) IN AN IN VITRO STUDY

Wu Shyh-Jong1, Tusty-Jiuan Hseih2, Chun-Hung Chen3, Yuan-Han Yang4, 1 Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung City, Taiwan; 2Kaohsiung Medical University, Kaohsiung, Taiwan; 3Kaohsiung Medical Hospital, Kaohsiung City, Taiwan; 4Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan. Background: Alzheimer’s disease (AD) is a complex disorder of the central nervous system that affects an increasing number of people worldwide. In