- Email: [email protected]
Moral judgment in Alzheimer's disease: A preliminary study
S490
Poster Presentations P3
difference between these two tests with respect to the ACE insertion/ deletion polymorphism. Chi-Square testing for trend was performed to evaluate the association ACE indel polymorphism with vascular cognitive decline; and logistic regression adjusting for the effects of age, education, gender, and ACE indel polymorphism to evaluate the factors influencing cognitive decline in post-lacunar infarct patients. Results: Among the 65 lacunar infarct patients, 23(35.4%) were women, the mean age was 64.46 6 12.35 years (26w88 years old). Twenty-two (33.8%) patients had senior high school education at least, but 10(15.4%) patients were illiterate. After ACE indel polymorphism analysis, 65 of our patients, 7(10.8%) were D/D genotype, 29(44.6%) were I/I genotype, and 29(44.6%) were I/D genotype. In our study, only fluency decline had trended to be not associated with D/D genotype (p ¼ 0.063) in Chi-square testing for trend. CASI (p ¼ 0.407) and MMSE (p ¼ 0.997) did not show significant cognitive decline between these three genotype. After logistic regression analysis, we also did not found any significant difference between cognitive decline and ACE indel polymorphism in post-lacunar infarct patients. Conclusions: Our results can not revealed that ACE indel polymorphism is a predictor of cognitive decline in post-lacunar infarct patients. A partial explanation for this may be that the number of subjects in this study was small, and may not be able to validate the hypothesis estimate exactly. So, extent our study times to collect more patients and long term follow up our cases that may be a reasonable method to improve our results. P3-137
NEUROPSYCHOLOGICAL ASSESSMENT OF MILD COGNITIVE IMPAIRMENT
Bernadette McGuinness, John McIlvenna, Aine Wallace, David Craig, Janet Johnston, Peter Passmore, Queen’s University of Belfast, Belfast, United Kingdom. Contact e-mail: [email protected] Background: Mild Cognitive Impairment (MCI) is the primary focus of much research. MCI has traditionally been associated with a mild memory deficit and a preserved level of function. There is growing evidence that in addition to memory difficulties, individuals may present with impairments in other cognitive domains. The purpose of this study was to carry out a full neurocognitive assessment on patients with MCI. We wished to determine if patients with MCI have deficits in cognitive domains other than memory. Methods: Patients were recruited from the memory clinic at the Belfast City Hospital. Control subjects were also recruited. Both patients and controls were invited to undergo a neuropsychological test battery. The examination comprised tests for pre morbid IQ (NART), immediate and delayed recall (NYU paragraph 1&2), executive function and attention (CLOX 1, Colour Trails 1&2, Stroop, Hayling Sentence Completion Test), language (COWAT verbal fluency test) and visuospatial function (Brixton Spatial Anticipation Test, CLOX 2). Results: 102 MCI patients and 55 controls were assessed. There was no difference in age, gender, education or pre-morbid IQ between the groups. Function as measured by the Disability Assessment for Dementia (DAD) did not differ between the groups. Mean MMSE in the MCI group was 27.9 (sd1.7) and in the control group was 29.6 (sd0.7). ANCOVA analysis revealed a significant difference between the groups in the domains of immediate recall (p < 0.01), delayed recall (p < 0.01), executive function (p < 0.01), attention (p < 0.01), language (p < 0.01) and visuospatial function (p ¼ 0.02). Conclusions: We demonstrated significant impairments in cognitive domains other than memory in this cohort of MCI patients. This illustrates the importance of carrying out a full neurocognitive assessment on patients presenting to a memory clinic. We wish to further this research by following these patients over time. P3-138
MORAL JUDGMENT IN ALZHEIMER’S DISEASE: A PRELIMINARY STUDY
Eun-Jin Kim, Ju-Won Ha, Yeo-Jin Kang, Se-Won Lim, Kang-Seob Oh, Kangbuk Samsung, Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Contact e-mail: [email protected] Background: Alzheimer’s disease (AD) is clinically characterized by cognitive impairment and behavioral disturbances. The aim of the study is to investigate the basis of disturbed moral judgement in patients with AD. Methods: 9 literate AD patients (Mini Mental Status Examination score ¼
10w23, Clinical Dementia Rating ¼ 1w2) and age, education matched 11 healthy volunteers made judgement on a series of 15 hypothetical scenarios. To test for between-group differences in the probability of utilitarian responses given for three scenario type: non-moral (n ¼ 5), impersonal-moral (n ¼ 5), personal-moral (n ¼ 5). Subjects answered ‘yes’ (utilitarian response) or ‘no’ on the scenarios and reaction-time was examined in the all scenarios. Mini International Neuropsychiatric Interview and Hamilton Rating Scale for Depression were measured for exclusion of depression or other psychiatric disorders. Results: There were no statistically significant differences in the utilitarian responses between two groups on the non-moral (p ¼ 0.601), impersonal-moral (p ¼ 0.989), and personal-moral scenarios (p ¼ 0.102). The frequency of utilitarian response in the normal group on nonmoral scenarios was significantly greater than personal-moral scenarios (F ¼ 4.460, p ¼ 0.020), but there were no significant differences among three scenarios in the AD group (F ¼ 1.356, p ¼ 0.277). The reaction-time data did not show significant differences between two groups on the non-moral (p ¼ 0.946), impersonal-moral (p ¼ 0.652), and personal-moral scenarios (p ¼ 0.391). Conclusions: These findings indicate that AD patients were impaired in their ability to make emotionally based moral judgements compared with the normal group. Further investigations with a larger sample size and more controlled study design are warranted to clarify the relationship of moral judgement and the brain. P3-139
PSYCHOMETRIC COMPARISON OF STANDARD AND COMPUTERIZED ADMINISTRATION OF THE ALZHEIMER’S DISEASE ASSESSMENT SCALE (ADAS) AMONG PATIENTS WITH MILD-TO-MODERATE ALZHEIMER’S DISEASE
Aaron S. Kemp1, Richard Mohs2,3, David Salmon4, Pierre Tariot5, M. Saleem Ismail6, Lon S. Schneider7, James P. O’Halloran8, 1University of California, Irvine School of Medicine, Orange, CA, USA; 2Mount Sinai School of Medicine, New York, NY, USA; 3Eli Lilly & Company, Indianapolis, IN, USA; 4Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, CA, USA; 5Banner Alzheimer’s Institute, University of Arizona, College of Medicine, Phoenix, AZ, USA; 6Monroe Community Hospital, University of Rochester, Rochester, NY, USA; 7University of Southern California, Keck School of Medicine, Los Angeles, CA, USA; 8NeuroComp Systems, Inc., Irvine, CA, USA. Contact e-mail: akemp@ uci.edu Background: The Alzheimer’s Disease Assessment Scale (ADAS) has become the de facto ‘‘gold-standard’’ for assessing the putative efficacy of anti-dementia treatments. However, manual administration of the ADAS is often fraught with procedural inconsistencies, including scoring and transcription errors, which can introduce unwanted variance and compromise data quality within and across sites. To address such concerns, a unique, dual-monitor, computerized version was developed under an exclusive licensing agreement with the Mount Sinai School of Medicine and funding from the National Institute on Aging (#R43AG19572). The dual-monitor schema integrates rather than replaces the examiner while standardizing administration procedures and eliminating paper forms with electronic data capture at the point-of-contact. The examiner controls administration and pacing, can pause or repeat digitized aural instructions, score verbal report and overt behavioral performance, and freely interact with the subject, as required. Methods: To conduct psychometric comparisons of traditional, paper-based administration of the standard ADAS (sADAS) with examinerassisted administration of the computerized ADAS (cADAS), 88 outpatients (39M;49F) with mild to moderate AD were tested thrice with each over one year with one month between paired visits. Results: Intraclass Correlation Coefficient (ICC) comparisons between sADAS and cADAS were highly significant for total score (ICC ¼ 0.96) and all subscores (ICCs ranged 0.78-0.93), and no significant differences were found on paired t-test comparisons. A paired t-test was also conducted to compare test-retest reliability values between the two methods. This revealed that the mean ICC for the cADAS (0.86) was significantly larger (t ¼ 3.01; p < .01) than the mean ICC for the sADAS (0.80). Conclusions: These results indicate that the computerized version of the ADAS exhibits substantial equivalence with the
Poster Presentations P3
difference between these two tests with respect to the ACE insertion/ deletion polymorphism. Chi-Square testing for trend was performed to evaluate the association ACE indel polymorphism with vascular cognitive decline; and logistic regression adjusting for the effects of age, education, gender, and ACE indel polymorphism to evaluate the factors influencing cognitive decline in post-lacunar infarct patients. Results: Among the 65 lacunar infarct patients, 23(35.4%) were women, the mean age was 64.46 6 12.35 years (26w88 years old). Twenty-two (33.8%) patients had senior high school education at least, but 10(15.4%) patients were illiterate. After ACE indel polymorphism analysis, 65 of our patients, 7(10.8%) were D/D genotype, 29(44.6%) were I/I genotype, and 29(44.6%) were I/D genotype. In our study, only fluency decline had trended to be not associated with D/D genotype (p ¼ 0.063) in Chi-square testing for trend. CASI (p ¼ 0.407) and MMSE (p ¼ 0.997) did not show significant cognitive decline between these three genotype. After logistic regression analysis, we also did not found any significant difference between cognitive decline and ACE indel polymorphism in post-lacunar infarct patients. Conclusions: Our results can not revealed that ACE indel polymorphism is a predictor of cognitive decline in post-lacunar infarct patients. A partial explanation for this may be that the number of subjects in this study was small, and may not be able to validate the hypothesis estimate exactly. So, extent our study times to collect more patients and long term follow up our cases that may be a reasonable method to improve our results. P3-137
NEUROPSYCHOLOGICAL ASSESSMENT OF MILD COGNITIVE IMPAIRMENT
Bernadette McGuinness, John McIlvenna, Aine Wallace, David Craig, Janet Johnston, Peter Passmore, Queen’s University of Belfast, Belfast, United Kingdom. Contact e-mail: [email protected] Background: Mild Cognitive Impairment (MCI) is the primary focus of much research. MCI has traditionally been associated with a mild memory deficit and a preserved level of function. There is growing evidence that in addition to memory difficulties, individuals may present with impairments in other cognitive domains. The purpose of this study was to carry out a full neurocognitive assessment on patients with MCI. We wished to determine if patients with MCI have deficits in cognitive domains other than memory. Methods: Patients were recruited from the memory clinic at the Belfast City Hospital. Control subjects were also recruited. Both patients and controls were invited to undergo a neuropsychological test battery. The examination comprised tests for pre morbid IQ (NART), immediate and delayed recall (NYU paragraph 1&2), executive function and attention (CLOX 1, Colour Trails 1&2, Stroop, Hayling Sentence Completion Test), language (COWAT verbal fluency test) and visuospatial function (Brixton Spatial Anticipation Test, CLOX 2). Results: 102 MCI patients and 55 controls were assessed. There was no difference in age, gender, education or pre-morbid IQ between the groups. Function as measured by the Disability Assessment for Dementia (DAD) did not differ between the groups. Mean MMSE in the MCI group was 27.9 (sd1.7) and in the control group was 29.6 (sd0.7). ANCOVA analysis revealed a significant difference between the groups in the domains of immediate recall (p < 0.01), delayed recall (p < 0.01), executive function (p < 0.01), attention (p < 0.01), language (p < 0.01) and visuospatial function (p ¼ 0.02). Conclusions: We demonstrated significant impairments in cognitive domains other than memory in this cohort of MCI patients. This illustrates the importance of carrying out a full neurocognitive assessment on patients presenting to a memory clinic. We wish to further this research by following these patients over time. P3-138
MORAL JUDGMENT IN ALZHEIMER’S DISEASE: A PRELIMINARY STUDY
Eun-Jin Kim, Ju-Won Ha, Yeo-Jin Kang, Se-Won Lim, Kang-Seob Oh, Kangbuk Samsung, Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Contact e-mail: [email protected] Background: Alzheimer’s disease (AD) is clinically characterized by cognitive impairment and behavioral disturbances. The aim of the study is to investigate the basis of disturbed moral judgement in patients with AD. Methods: 9 literate AD patients (Mini Mental Status Examination score ¼
10w23, Clinical Dementia Rating ¼ 1w2) and age, education matched 11 healthy volunteers made judgement on a series of 15 hypothetical scenarios. To test for between-group differences in the probability of utilitarian responses given for three scenario type: non-moral (n ¼ 5), impersonal-moral (n ¼ 5), personal-moral (n ¼ 5). Subjects answered ‘yes’ (utilitarian response) or ‘no’ on the scenarios and reaction-time was examined in the all scenarios. Mini International Neuropsychiatric Interview and Hamilton Rating Scale for Depression were measured for exclusion of depression or other psychiatric disorders. Results: There were no statistically significant differences in the utilitarian responses between two groups on the non-moral (p ¼ 0.601), impersonal-moral (p ¼ 0.989), and personal-moral scenarios (p ¼ 0.102). The frequency of utilitarian response in the normal group on nonmoral scenarios was significantly greater than personal-moral scenarios (F ¼ 4.460, p ¼ 0.020), but there were no significant differences among three scenarios in the AD group (F ¼ 1.356, p ¼ 0.277). The reaction-time data did not show significant differences between two groups on the non-moral (p ¼ 0.946), impersonal-moral (p ¼ 0.652), and personal-moral scenarios (p ¼ 0.391). Conclusions: These findings indicate that AD patients were impaired in their ability to make emotionally based moral judgements compared with the normal group. Further investigations with a larger sample size and more controlled study design are warranted to clarify the relationship of moral judgement and the brain. P3-139
PSYCHOMETRIC COMPARISON OF STANDARD AND COMPUTERIZED ADMINISTRATION OF THE ALZHEIMER’S DISEASE ASSESSMENT SCALE (ADAS) AMONG PATIENTS WITH MILD-TO-MODERATE ALZHEIMER’S DISEASE
Aaron S. Kemp1, Richard Mohs2,3, David Salmon4, Pierre Tariot5, M. Saleem Ismail6, Lon S. Schneider7, James P. O’Halloran8, 1University of California, Irvine School of Medicine, Orange, CA, USA; 2Mount Sinai School of Medicine, New York, NY, USA; 3Eli Lilly & Company, Indianapolis, IN, USA; 4Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, CA, USA; 5Banner Alzheimer’s Institute, University of Arizona, College of Medicine, Phoenix, AZ, USA; 6Monroe Community Hospital, University of Rochester, Rochester, NY, USA; 7University of Southern California, Keck School of Medicine, Los Angeles, CA, USA; 8NeuroComp Systems, Inc., Irvine, CA, USA. Contact e-mail: akemp@ uci.edu Background: The Alzheimer’s Disease Assessment Scale (ADAS) has become the de facto ‘‘gold-standard’’ for assessing the putative efficacy of anti-dementia treatments. However, manual administration of the ADAS is often fraught with procedural inconsistencies, including scoring and transcription errors, which can introduce unwanted variance and compromise data quality within and across sites. To address such concerns, a unique, dual-monitor, computerized version was developed under an exclusive licensing agreement with the Mount Sinai School of Medicine and funding from the National Institute on Aging (#R43AG19572). The dual-monitor schema integrates rather than replaces the examiner while standardizing administration procedures and eliminating paper forms with electronic data capture at the point-of-contact. The examiner controls administration and pacing, can pause or repeat digitized aural instructions, score verbal report and overt behavioral performance, and freely interact with the subject, as required. Methods: To conduct psychometric comparisons of traditional, paper-based administration of the standard ADAS (sADAS) with examinerassisted administration of the computerized ADAS (cADAS), 88 outpatients (39M;49F) with mild to moderate AD were tested thrice with each over one year with one month between paired visits. Results: Intraclass Correlation Coefficient (ICC) comparisons between sADAS and cADAS were highly significant for total score (ICC ¼ 0.96) and all subscores (ICCs ranged 0.78-0.93), and no significant differences were found on paired t-test comparisons. A paired t-test was also conducted to compare test-retest reliability values between the two methods. This revealed that the mean ICC for the cADAS (0.86) was significantly larger (t ¼ 3.01; p < .01) than the mean ICC for the sADAS (0.80). Conclusions: These results indicate that the computerized version of the ADAS exhibits substantial equivalence with the