- Email: [email protected]
LONGITUDINAL ANALYSIS OF THE FREE AND CUED SELECTIVE REMINDING TEST IN PRE-CLINICAL AND CLINICAL ALZHEIMER'S DISEASE: TEMPORAL UNFOLDING OF STAGES OF MEMORY IMPAIRMENT
P568
Poster Presentations: Sunday, July 24, 2016
Werner Wahl2, Ute Kunzmann5, Peter Schonknecht6, Johannes Schr€oder7, 1 Section of Geriatric Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; 2Institute of Psychology, Heidelberg University, Heidelberg, Germany; 3Institute of Psychology, Leipzig University, Leipzig, Germany; 4University Hospital Leipzig, Leipzig, Germany; 5Institute of Psychology, University Leipzig, Leipzig, Germany; 6Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany; 7Institute of Gerontology, University of Heidelberg, Heidelberg, Germany. Contact e-mail: [email protected] Background: Recent studies indicate a steady improvement in
neuropsychological functioning between generations which may lead to a decreased dementia risk. However, research remains inconclusive, as different birth cohorts need to be examined at the same age to adequately study this observation. Initiated in 1992, the Interdisciplinary Longitudinal Study of Adult Ageing (ILSE) was designed to directly compare neuropsychological development in aging between two birth cohorts born between 1930-32 or 1950-52. Methods: Neuropsychological functioning was assessed using the same instruments assessing memory (subtests word list of the Nuremberg Age Inventory), verbal fluency, visuo-spatial thinking (“Leistungspr€ufsystem”), intelligence (Wechsler Intelligence Test battery) and attention (attentiveness endurance test “d2”) over a period of >20 years. Using analyses of variance we were able to contrast neuropsychological functioning of the younger birth cohort at the fourth examination (mean age 63.37 +/- 0.54 years) and the older birth cohort at the second examination wave (mean age 66.41 +/- 0.97 years). Results: Up to now, 40% of the 1002 initially recruited were re-examined. Prevalence of MCI is app. 9% as opposed to 24% for the older birth cohort in the second examination wave. The young outperformed the old cohort with respect to general intelligence (F¼16.29, p<.001), visuo-spatial thinking (F¼11.80, p¼.0006), attention (F¼6.02, p¼.0144), learning (F¼10.28, p¼.0014) and memory (F¼41.82, p<.001). These results were confirmed after adjusting for years of education. Conclusions: Superior functioning in the young cohort confirms steady improvement in cognition between generations and is only partly explained by educational differences. These differences may well translate into a lower dementia risk.
P1-362
LONGITUDINAL ANALYSIS OF THE FREE AND CUED SELECTIVE REMINDING TEST IN PRECLINICAL AND CLINICAL ALZHEIMER’S DISEASE: TEMPORAL UNFOLDING OF STAGES OF MEMORY IMPAIRMENT
Ellen Grober1, Amy E. Veroff2, Richard B. Lipton1, 1Albert Einstein College of Medicine, Bronx, NY, USA; 2Consultant, Bethesda, MD, USA. Contact e-mail: [email protected] Background: The proposed Objective Memory Impairment Clas-
sification system (OMICs) describes the trajectory of memory decline in preclinical and clinical AD as a sequence of stages defined by free recall (FR) and total recall (TR) score ranges on the picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT+IR). Methods: The OMICs
Poster Presentations: Sunday, July 24, 2016
P569
Table The Objective Memory Impairment Classification system (OMICs) and the free and total recall scores of the 149 preclinical AD cases from the Einstein Aging Study on the picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT+IR) pFCSRT+IR scores assigned to OMICs stage according to when the test was administered before clinical diagnosis
Description of the OMICs OMICs Stage
Preclinical and Clinical period
Preclinical and Clinical stages
Free Recall (max¼48)
Total Recall (max¼48)
Free Recall (mean)
0 1 2 3 4 5
> 7 years 7-5 years 5-3 years 3-0 years 0 years < 0-3years
No Ml Pre-aMCI aMCI ADProdrome Incipient AD Mild AD
>30 30-28 27-25 24-20 19-15 14-10
>46 >46 >46 46-44 43-40 <40
31.2 29.0 26.1 21.1 15.0 12.6
was based on published data, including the change point model for FR from the Baltimore Longitudinal Study of Aging (Grober et al, 2008). FR was stable up to 7 years before AD diagnosis, then declined steadily until 3 years when the rate doubled. Impaired TR, the core clinical phenotype of the IWG-2 criteria for prodromal AD, emerges at this time. The OMICs was applied to the FR and TR scores of 148 AD cases that developed out of 1448 Einstein Aging Study participants initially dementia-free. Each data wave was assigned to the stage predicted by the OMICs according to when in the preclinical or clinical period the assessment was conducted. Descriptive statistics were computed for FR and TR at each OMICs stage and spaghetti plots displayed the trajectory of FR and TR decline. Results: The prescribed ranges for FR and TR at each OMICs stage fell within the 95% CI of the mean FR and TR scores assigned to that stage (Table). Trajectories for FR and TR appear consistent with expectations: FR declined at 7-8 years with more rapid decline at 3 years (Figure 1); TR was unimpaired (>46) until 3 years before diagnosis when decline began (Figure 2). The look-up-table (Figure3) classifies patients into OMICs stages based on their FR and TR scores. A patient with 28 in FR and 47 in TR would be assigned to the pre-aMCI stage; a patient with 23 in FR and 45 in TR would be assigned to the prodromal stage. Conclusions: The results support our proposed OMICs model. Analyses are underway to determine how well the model prospectively classifies individuals into the prescribed stages. The ultimate objective is to enable more accurate diagnosis and serve as a cost-effective screening tool for secondary AD clinical trials. Grober, 2008, JINS, 14,266.
P1-363
NOT YET MCI: HOW TO DETECT SUBTLE COGNITIVE IMPAIRMENT?
Elena Chipi1, Nicola Salvadori1, Paolo Eusebi1, Lucia Farotti1, Viviana Lisetti1, Giulia Frattini1, Francesca Baschieri1, Federica Nicoletta Sepe1, Elisa Luchetti1, Davide Chiasserini1, Paolo Calabresi1,2, Lucilla Parnetti1, 1University of Perugia, Perugia, Italy; 2 IRCSS Santa Lucia Foundation, Rome, Italy. Contact e-mail: elena.chipi@ outlook.com
95% CI lower
upper
Total Recall (mean)
30.0 27.7 25.0 20.2 13.8 11.0
32.4 30.4 27.2 21.9 16.3 14.2
47.7 47.1 46.8 44.4 38.0 34.8
95% CI lower
upper
47.5 46.3 46.3 43.8 36.2 32.2
47.8 47.9 47.2 45.1 39.9 37.4
Background: Several studies have been focused on the long preclinical phase of Alzheimer’s Disease (AD)1. Evidences suggest that subjective cognitive decline (SCD) may represent the first symptomatic manifestation of AD2. Standardized cognitive tests, for detecting subtle cognitive impairment characterizing this phase, are not defined yet. To this aim we wanted to test the usefulness of the Cambridge Neuropsychological Test Automated Battery (CANTAB) in a cohort of SCD subjects showing subtle cognitive deficits and followed over time (mean ¼ 1.5 year, range: 1-4 years). Methods: 20 consecutive subjects (7 males, 13 females, mean age¼726 7.6), referred to our Memory Clinic for complaints of memory disturbance, underwent standard neuropsychological examination (MMSE, RAVLT) and CANTAB (visual-spatial memory tests: PRM, PAL; executive function tests: SWM, SOC). Subjects showed normal scores at standard evaluation and altered scores (-1 SD) in
Poster Presentations: Sunday, July 24, 2016
Werner Wahl2, Ute Kunzmann5, Peter Schonknecht6, Johannes Schr€oder7, 1 Section of Geriatric Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; 2Institute of Psychology, Heidelberg University, Heidelberg, Germany; 3Institute of Psychology, Leipzig University, Leipzig, Germany; 4University Hospital Leipzig, Leipzig, Germany; 5Institute of Psychology, University Leipzig, Leipzig, Germany; 6Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany; 7Institute of Gerontology, University of Heidelberg, Heidelberg, Germany. Contact e-mail: [email protected] Background: Recent studies indicate a steady improvement in
neuropsychological functioning between generations which may lead to a decreased dementia risk. However, research remains inconclusive, as different birth cohorts need to be examined at the same age to adequately study this observation. Initiated in 1992, the Interdisciplinary Longitudinal Study of Adult Ageing (ILSE) was designed to directly compare neuropsychological development in aging between two birth cohorts born between 1930-32 or 1950-52. Methods: Neuropsychological functioning was assessed using the same instruments assessing memory (subtests word list of the Nuremberg Age Inventory), verbal fluency, visuo-spatial thinking (“Leistungspr€ufsystem”), intelligence (Wechsler Intelligence Test battery) and attention (attentiveness endurance test “d2”) over a period of >20 years. Using analyses of variance we were able to contrast neuropsychological functioning of the younger birth cohort at the fourth examination (mean age 63.37 +/- 0.54 years) and the older birth cohort at the second examination wave (mean age 66.41 +/- 0.97 years). Results: Up to now, 40% of the 1002 initially recruited were re-examined. Prevalence of MCI is app. 9% as opposed to 24% for the older birth cohort in the second examination wave. The young outperformed the old cohort with respect to general intelligence (F¼16.29, p<.001), visuo-spatial thinking (F¼11.80, p¼.0006), attention (F¼6.02, p¼.0144), learning (F¼10.28, p¼.0014) and memory (F¼41.82, p<.001). These results were confirmed after adjusting for years of education. Conclusions: Superior functioning in the young cohort confirms steady improvement in cognition between generations and is only partly explained by educational differences. These differences may well translate into a lower dementia risk.
P1-362
LONGITUDINAL ANALYSIS OF THE FREE AND CUED SELECTIVE REMINDING TEST IN PRECLINICAL AND CLINICAL ALZHEIMER’S DISEASE: TEMPORAL UNFOLDING OF STAGES OF MEMORY IMPAIRMENT
Ellen Grober1, Amy E. Veroff2, Richard B. Lipton1, 1Albert Einstein College of Medicine, Bronx, NY, USA; 2Consultant, Bethesda, MD, USA. Contact e-mail: [email protected] Background: The proposed Objective Memory Impairment Clas-
sification system (OMICs) describes the trajectory of memory decline in preclinical and clinical AD as a sequence of stages defined by free recall (FR) and total recall (TR) score ranges on the picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT+IR). Methods: The OMICs
Poster Presentations: Sunday, July 24, 2016
P569
Table The Objective Memory Impairment Classification system (OMICs) and the free and total recall scores of the 149 preclinical AD cases from the Einstein Aging Study on the picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT+IR) pFCSRT+IR scores assigned to OMICs stage according to when the test was administered before clinical diagnosis
Description of the OMICs OMICs Stage
Preclinical and Clinical period
Preclinical and Clinical stages
Free Recall (max¼48)
Total Recall (max¼48)
Free Recall (mean)
0 1 2 3 4 5
> 7 years 7-5 years 5-3 years 3-0 years 0 years < 0-3years
No Ml Pre-aMCI aMCI ADProdrome Incipient AD Mild AD
>30 30-28 27-25 24-20 19-15 14-10
>46 >46 >46 46-44 43-40 <40
31.2 29.0 26.1 21.1 15.0 12.6
was based on published data, including the change point model for FR from the Baltimore Longitudinal Study of Aging (Grober et al, 2008). FR was stable up to 7 years before AD diagnosis, then declined steadily until 3 years when the rate doubled. Impaired TR, the core clinical phenotype of the IWG-2 criteria for prodromal AD, emerges at this time. The OMICs was applied to the FR and TR scores of 148 AD cases that developed out of 1448 Einstein Aging Study participants initially dementia-free. Each data wave was assigned to the stage predicted by the OMICs according to when in the preclinical or clinical period the assessment was conducted. Descriptive statistics were computed for FR and TR at each OMICs stage and spaghetti plots displayed the trajectory of FR and TR decline. Results: The prescribed ranges for FR and TR at each OMICs stage fell within the 95% CI of the mean FR and TR scores assigned to that stage (Table). Trajectories for FR and TR appear consistent with expectations: FR declined at 7-8 years with more rapid decline at 3 years (Figure 1); TR was unimpaired (>46) until 3 years before diagnosis when decline began (Figure 2). The look-up-table (Figure3) classifies patients into OMICs stages based on their FR and TR scores. A patient with 28 in FR and 47 in TR would be assigned to the pre-aMCI stage; a patient with 23 in FR and 45 in TR would be assigned to the prodromal stage. Conclusions: The results support our proposed OMICs model. Analyses are underway to determine how well the model prospectively classifies individuals into the prescribed stages. The ultimate objective is to enable more accurate diagnosis and serve as a cost-effective screening tool for secondary AD clinical trials. Grober, 2008, JINS, 14,266.
P1-363
NOT YET MCI: HOW TO DETECT SUBTLE COGNITIVE IMPAIRMENT?
Elena Chipi1, Nicola Salvadori1, Paolo Eusebi1, Lucia Farotti1, Viviana Lisetti1, Giulia Frattini1, Francesca Baschieri1, Federica Nicoletta Sepe1, Elisa Luchetti1, Davide Chiasserini1, Paolo Calabresi1,2, Lucilla Parnetti1, 1University of Perugia, Perugia, Italy; 2 IRCSS Santa Lucia Foundation, Rome, Italy. Contact e-mail: elena.chipi@ outlook.com
95% CI lower
upper
Total Recall (mean)
30.0 27.7 25.0 20.2 13.8 11.0
32.4 30.4 27.2 21.9 16.3 14.2
47.7 47.1 46.8 44.4 38.0 34.8
95% CI lower
upper
47.5 46.3 46.3 43.8 36.2 32.2
47.8 47.9 47.2 45.1 39.9 37.4
Background: Several studies have been focused on the long preclinical phase of Alzheimer’s Disease (AD)1. Evidences suggest that subjective cognitive decline (SCD) may represent the first symptomatic manifestation of AD2. Standardized cognitive tests, for detecting subtle cognitive impairment characterizing this phase, are not defined yet. To this aim we wanted to test the usefulness of the Cambridge Neuropsychological Test Automated Battery (CANTAB) in a cohort of SCD subjects showing subtle cognitive deficits and followed over time (mean ¼ 1.5 year, range: 1-4 years). Methods: 20 consecutive subjects (7 males, 13 females, mean age¼726 7.6), referred to our Memory Clinic for complaints of memory disturbance, underwent standard neuropsychological examination (MMSE, RAVLT) and CANTAB (visual-spatial memory tests: PRM, PAL; executive function tests: SWM, SOC). Subjects showed normal scores at standard evaluation and altered scores (-1 SD) in