- Email: [email protected]
Nutritional status and progression of dementia: The Cache County dementia progression study
Poster Presentations: P4 P4-084
ALZHEIMER’S DISEASE DIAGNOSIS BY DETECTING EXOGENEOUS FLUORESCENT SIGNAL OF LIGAND BOUND TO BETA-AMYLOID IN THE LENSES OF HUMAN EYES: AN EXPLORATORY STUDY
Charles Kerbage1, Carl Sadowsky2, Danna Jennings3, Gerald Cagle1, Paul Hartung1, 1Cognoptix Inc, Acton, Massachusetts, United States; 2 Nova Southeastern University, Fort Lauderdale-Davie, Florida, United States; 3Institute for Neurodegenerative Disorders 2Nova Southeastern University, Fort Lauderdale-Davie, Florida, United States. Contact e-mail: [email protected] Background: Currently, definite diagnosis of Alzheimer’s disease (AD) is performed post mortem through histopathological identification of characteristic features including beta-amyloid plaques. Recent studies have been investigating the presence of beta-amyloid in the human and animal model eyes as a non-invasive technique to aid in the diagnosis of the disease. In particular, the presence of Ab deposits in the supranucleus of the lens of the eye has been confirmed in a population with AD determined by autopsy and differentiated from control samples. Methods: A clinical exploratory study involving ten participants, five AD patients and five Normal Controls, was performed with the SAPPHIRE System, which is a combination of a fluorescent ligand and a Class I laser scanning device. The fluorescent ligand, formulated at 0.5% into an ophthalmic ointment, was dosed topically to the inside of the lower eyelid of the study eyes. The laser scanning device identifies the supranucleus and detects specific fluorescent signature, which is characterized by the lifetime measurement of the ligand bound to beta-amyloid in the region of interest in the human lens. Measurements were carried out at t hree different locations in the supranucleus of the lens. Results: Mean fluorescent signature measurements were twofold higher in AD patients than those in the Control Group. Data from our studies indicates that deeper regions of the supranucleus provide the highest measures of ligand bound fluorescence signal from both controls and patients with AD. The clinical study was conducted with no serious adverse events related to the use of the fluorescent ligand or the laser scanning device in the eye. Conclusions: The results obtained from the SAPPHIRE System were encouraging in terms of bioavailability of the ligand in the anterior segment of the eye and the sensitivity of the device to differentiate between the AD patients and the Control group. Further clinical studies are underway involving a larger population for statistical evaluation of the method. P4-085
MULTISPECIALTY MEMORY CLINICS HARMONIZE DIAGNOSTIC OUTCOME
Peter Johannsen1, Per Maegaard Poulsen2, Alex Kørner3, Gunhild Waldemar4, 1Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 2Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark; 3Psychiatric Center North Zealand, Copenhagen University Hospital, Hilleroed, Denmark; 4Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark. Contact e-mail: [email protected] Background: Correct diagnosis of all patients, including dementia patients, is imperative in order to be able to provide correct treatment and prognosis to the patient. In 2009 the clinical quality database for diagnostic evaluation of dementia in the Capital Region of Denmark showed a large variation in the frequency of especially vascular dementia (from 3 to 75% of diagnosed patients) between the sixteen secondary health care based memory clinics. Consequently, a large variation was also seen in other diagnoses, including Alzheimer’s disease (from 4 to 71%). In 2010 the organization was changed and 16 hospital-based mono-specialty units were merged to 6 multi-specialty units. This study assessed the diagnostic frequencies before and after the organizational changes, and we hypothesized that the creation of larger multispecialty clinics would improve the quality of diagnostic evaluations. Methods: The frequencies of specific dementia diagnoses were assessed for the subgroup of patients with dementia among all patients with dementia referred to each of the hospital based memory clinics in the Capital Region,
P735
Denmark. Patients with normal-pressure hydrocephalus and Huntington’s disease were excluded. The frequency is based on patients assigned a specific etiological diagnosis. For the 2009 and 2010 data sets, memory clinics with less than 20 evaluations were excluded. Results: The total number of referred patients and of patients with a diagnosis of dementia, as well as the frequency of the assigned specific diagnoses are listed in the table. The lowest and highest frequencies observed among the memory clinics are listed for Alzheimer’s disease (AD), vascular dementia (VaD) and Mixed (AD + VaD). Conclusions: Multispecialty memory clinics combined with a continued focus on diagnostic criteria seem to harmonize the frequency of different dementia diagnoses in-between clinics, although the frequency vascular dementia still varies 8 fold between lowest and highest frequency. The frequency of assigning a (any) specific diagnoses to patients seems to increase. 2009
2010
2011
2012
16
16
6
6
Number of evaluated patients, N 2109 2006 Frequency of dementia 64.3% 61.2% A specific dementia diagnosis Lowest 74% 70% Highest 100% 100%
2094 58.3% 82% 96%
2155 59.8% 81% 96%
Alzheimer’s disease
35% 60% 7% 18% 6% 41%
30% 62% 6% 21% 5% 39%
Number of memory clinics, N
Mixed dementia Vascular dementia
P4-086
Lowest Highest Lowest Highest Lowest Highest
4% 71% 4% 34% 3% 75%
25% 70% 0% 31% 7% 63%
DRAMATIC IMPROVEMENT WITH DONEPEZIL IN A CASE OF DEMENTIA WITH LEWY BODIES
Laura Allen1, Keith Josephs1, Sean Pittock1, Glenn E. Smith1, Robert Ivnik1, Val Lowe1, Bradley Boeve1, 1Mayo Clinic, Rochester, Minnesota, United States. Contact e-mail: [email protected] Background: While improvement is known to occur in DLB patients with cholinesterase inhibitor therapy, few have had detailed neuropsychological and neuroimaging assessments before and after commencement of treatment. Methods: Case Study Results: A 65 year old woman underwent evaluation at our institution after a 16 month history of progressive dementia, visual hallucinations, cognitive fluctuations, daytime hypersomnolence and parkinsonism. Initial exam revealed a Kokmen Short Test of Mental Status (STMS) score of 27/38 and mild parkinsonism. Neuropsychological testing showed a Dementia Rating Scale (DRS) was 126/144, with other measures showing prominent impairment in attention and concentration, processing speed, visuospatial functioning, novel problem solving and encoding of new information. Fluorodeoxyglucose positron emission tomography (FDG-PET) scan of the brain revealed moderately decreased activity in the posterior cingulate, parietal, occipital and frontal lobes with most Z-scores on projection maps being < -2. The features were considered consistent with DLB, and she was commenced on donepezil therapy 10 mg daily. Follow-up assessment 15 months later revealed that within weeks after donepezil treatment there was marked clinical improvement with functional independence. Her STMS score was 35/38. Her scores on neuropsychological assessment were much improved (DRS 139/144), especially in the realms of processing speed and acquisition and retention of data. Her FDG-PET scan findings were also markedly improved, with almost all Z-scores on projection maps being > -1. Conclusions: This case exemplifies the rare but impressive improvement in DLB patients that can occur with cholinesterase inhibitor therapy. P4-087
NUTRITIONAL STATUS AND PROGRESSION OF DEMENTIA: THE CACHE COUNTY DEMENTIA PROGRESSION STUDY
Chelsea Sanders1, Heidi Wengreen1, Christopher Corcoran1, Sarah Schwartz1, Maria Norton1, Constantine Lyketsos2, JoAnn Tschanz1,
P736
Poster Presentations: P4
1 Utah State University, Logan, Utah, United States; 2Johns Hopkins University, Baltimore, Maryland, United States. Contact e-mail: chelsea. [email protected]
30
Background: Few studies have examined nutritional status (i.e. well-nourished, risk for malnutrition, or malnourished), and its association with the progression of dementia after its onset. A large multi-center French study reported that malnourished Alzheimer’s patients declined more rapidly in a one-year follow-up. Here, we investigate the relationship between nutritional status and dementia progression in a U.S. population-based sample. Methods: We assessed 264 individuals with dementia (72% AD, 54% female) annually for up to 7.7 years. Mean (SD) ages of participants were 85.44 (5.60). At baseline and annual follow-ups, cognition was assessed with the Mini-Mental State Exam and functional ability with the Clinical Dementia Rating Sum of Boxes (CDR-sb). Nutritional status was assessed using a modified Mini Nutritional Assessment (mMNA), a well-established questionnaire commonly used to screen and assess malnutrition and risk of malnutrition in older adults. In linear mixed models, we examined change in mMNA over time, and its association with cognitive and functional decline in dementia. Covariates tested in all models included gender, education, dementia type, age of dementia onset, and dementia duration at baseline. Results: mMNA scores declined over time by approximately 0.50 points/year. Worse mMNA scores were associated with female gender, greater dementia onset age and dementia duration, non-AD dementia and worse overall health. Controlling for dementia duration at first visit and presence of 1+ APOE E4 allele, lower mMNA predicted a .10 point/year faster cognitive decline on the MMSE (p ¼ 0.006, ß¼.10). In the functional domain and controlling for dementia duration and dementia type, mMNA was associated with worse (higher) CDR-sb scores. Every 1-unit increase on the mMNA, corresponded to a .44 point higher score on CDR-sb. Conclusions: Assessment of risk for malnutrition is useful in predicting rates of decline in cognitive and functional domains, in persons with dementia. Future research will examine mMNA components that are most predictive of dementia progression.
MNA total
25 20 MMSE 15 10 5 0
2 4 6 Years Since First DPS Visit
8
Figure 1. Decline in MMSE total score in Alzheimer’s disease by mMNA score at the 25th, 50th, and 75th percentiles. P4-088
Background: In patients with dementia, including Alzheimer’s disease (AD), gait and balance disorders have been assessed by the number of falls, balance and gait test scoring, or gait analysis using electronic equipment while walking several meters. However, no study has analyzed gait changes in the daily life of patients with dementia. In this study, we recorded the gait of patients with AD by using a portable gait rhythmograph (PGR) for 24 h and assessed their gait characteristics. Methods: We assessed 14 patients with AD or mild cognitive impairment and 17 cognitively healthy controls. The PGR was attached to the waist of the patient, and the acceleration vector derived from the patient’s movement was recorded for 24 h. The amount of overall movement, mean amplitude of gait acceleration, and mean gait cycle were calculated from the data gathered from each patient during the 24-h period. Cognition was assessed by mini-mental state examination (MMSE). The relationship between cognitive impairment and gait parameters was analyzed by single regression analysis. Results: In patients with AD, the MMSE score showed a weak correlation with the amount of overall movement and mean gait acceleration, indicating that cognitive decline is related to decreased daily activity and floor reaction force. Among the patients with mild cognitive decline, some patients showed slower gait cycle. Conclusions: The main characteristic of the gait in patients with AD is a decrease in the total amount of movement and floor reaction force, which may be related to the instability and falls of AD patients. The slower gait observed in patients with mild cognitive decline may be compensation for gait instability. P4-089
INTERFERENCE OF COGNITIVE DISORDERS IN EVERYDAY LIFE: THE DIAGNOSTIC ACCURACY OF A NEW INSTRUMENTAL ACTIVITIES OF DAILY LIVING INSTRUMENT
Sietske Sikkes1, Yolande Pijnenburg1, Dirk Knol1, Elly de Lange - de Klerk1, Philip Scheltens1, Bernard Uitdehaag1, 1VU University Medical Center, Amsterdam, Netherlands. Contact e-mail: [email protected]
13 16 17.5
0
2 Tokyo Medical and Dental Univiersity, Tokyo, Japan; 3Tokyo Medical University, Tokyo, Japan; 4Tokyo Medical and Dental University Graduate School of Medical and Dental Science, Department of Neu, Tokyo, Japan. Contact e-mail: [email protected]
QUANTITATIVE ANALYSIS OF GAIT DISORDERS IN PEOPLE WITH ALZHEIMER’S DISEASE BY USING A PORTABLE GAIT RHYTHMOGRAPH
Maya Higuma1, Nobuo Sanjo2, Hiroshi Mitoma3, Yoko Ito1, Takumi Hori4, Hidehiro Mizusawa1, 1Tokyo Medical and Dental University, Tokyo, Japan;
Background: An important issue in the clinical diagnosis of dementia is how to quantify the level of interference of cognitive disorders in everyday life. Commonly used informant-based questionnaires aimed at ’instrumental activities of daily living’ (IADL) are generally outdated and have important quality limitations. We recently developed the Amsterdam IADL Questionnaire Ó (AIADL-Q), an instrument aimed at measuring IADL problems in early dementia. In the current study, we set out to investigate the diagnostic accuracy of the A-IADL-Q. Methods: In this prospective diagnostic study, consecutive referrals visiting the Alzheimer center of the VU University Medical center were included (n ¼ 278). Their informants, merely consisting of spouses, completed the A-IADL-Q. Patients were diagnosed using standard clinical diagnostic criteria for dementia (DSM-IV), independently of the A-IADL-Q scores. Diagnostic accuracy was investigated using receiver operating characteristic curves and area under the curves (AUC). An optimal cut-off point for the A-IADL-Q was determined and sensitivity, specificity and likelihood ratios (LR) were calculated for the A-IADL-Q, and the A-IADL-Q in combination with the MMSE. Results: The prevalence of dementia was 50.7%.Patients diagnosed with dementia had lower Amsterdam IADL scores (M¼45.78, SD¼8.30) than patients without dementia (M¼54.48, SD¼9.49), t(276)¼8.14, p<.001. Overall diagnostic accuracy based on the AUC was 0.75 (95%CI: 0.70-0.81) for the A-IADL-Q. The optimal cut-off score for the A-IADL-Q was set at 51.4, resulting in a sensitivity of 0.75 and specificity of 0.66. Combining the A-IADL-Q with the MMSE greatly improved specificity (0.94) and LR+ (9.0) when tests were used in series. Conclusions: In this study, we found a good diagnostic accuracy for A-IADL-Q, which improved further when combined with the MMSE. With a pragmatic approach, we showed that a positive result on both MMSE and A-IADL-Q is a strong indicator of dementia. These results support the role of the A-IADL-Q in diagnosing dementia.
ALZHEIMER’S DISEASE DIAGNOSIS BY DETECTING EXOGENEOUS FLUORESCENT SIGNAL OF LIGAND BOUND TO BETA-AMYLOID IN THE LENSES OF HUMAN EYES: AN EXPLORATORY STUDY
Charles Kerbage1, Carl Sadowsky2, Danna Jennings3, Gerald Cagle1, Paul Hartung1, 1Cognoptix Inc, Acton, Massachusetts, United States; 2 Nova Southeastern University, Fort Lauderdale-Davie, Florida, United States; 3Institute for Neurodegenerative Disorders 2Nova Southeastern University, Fort Lauderdale-Davie, Florida, United States. Contact e-mail: [email protected] Background: Currently, definite diagnosis of Alzheimer’s disease (AD) is performed post mortem through histopathological identification of characteristic features including beta-amyloid plaques. Recent studies have been investigating the presence of beta-amyloid in the human and animal model eyes as a non-invasive technique to aid in the diagnosis of the disease. In particular, the presence of Ab deposits in the supranucleus of the lens of the eye has been confirmed in a population with AD determined by autopsy and differentiated from control samples. Methods: A clinical exploratory study involving ten participants, five AD patients and five Normal Controls, was performed with the SAPPHIRE System, which is a combination of a fluorescent ligand and a Class I laser scanning device. The fluorescent ligand, formulated at 0.5% into an ophthalmic ointment, was dosed topically to the inside of the lower eyelid of the study eyes. The laser scanning device identifies the supranucleus and detects specific fluorescent signature, which is characterized by the lifetime measurement of the ligand bound to beta-amyloid in the region of interest in the human lens. Measurements were carried out at t hree different locations in the supranucleus of the lens. Results: Mean fluorescent signature measurements were twofold higher in AD patients than those in the Control Group. Data from our studies indicates that deeper regions of the supranucleus provide the highest measures of ligand bound fluorescence signal from both controls and patients with AD. The clinical study was conducted with no serious adverse events related to the use of the fluorescent ligand or the laser scanning device in the eye. Conclusions: The results obtained from the SAPPHIRE System were encouraging in terms of bioavailability of the ligand in the anterior segment of the eye and the sensitivity of the device to differentiate between the AD patients and the Control group. Further clinical studies are underway involving a larger population for statistical evaluation of the method. P4-085
MULTISPECIALTY MEMORY CLINICS HARMONIZE DIAGNOSTIC OUTCOME
Peter Johannsen1, Per Maegaard Poulsen2, Alex Kørner3, Gunhild Waldemar4, 1Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 2Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark; 3Psychiatric Center North Zealand, Copenhagen University Hospital, Hilleroed, Denmark; 4Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark. Contact e-mail: [email protected] Background: Correct diagnosis of all patients, including dementia patients, is imperative in order to be able to provide correct treatment and prognosis to the patient. In 2009 the clinical quality database for diagnostic evaluation of dementia in the Capital Region of Denmark showed a large variation in the frequency of especially vascular dementia (from 3 to 75% of diagnosed patients) between the sixteen secondary health care based memory clinics. Consequently, a large variation was also seen in other diagnoses, including Alzheimer’s disease (from 4 to 71%). In 2010 the organization was changed and 16 hospital-based mono-specialty units were merged to 6 multi-specialty units. This study assessed the diagnostic frequencies before and after the organizational changes, and we hypothesized that the creation of larger multispecialty clinics would improve the quality of diagnostic evaluations. Methods: The frequencies of specific dementia diagnoses were assessed for the subgroup of patients with dementia among all patients with dementia referred to each of the hospital based memory clinics in the Capital Region,
P735
Denmark. Patients with normal-pressure hydrocephalus and Huntington’s disease were excluded. The frequency is based on patients assigned a specific etiological diagnosis. For the 2009 and 2010 data sets, memory clinics with less than 20 evaluations were excluded. Results: The total number of referred patients and of patients with a diagnosis of dementia, as well as the frequency of the assigned specific diagnoses are listed in the table. The lowest and highest frequencies observed among the memory clinics are listed for Alzheimer’s disease (AD), vascular dementia (VaD) and Mixed (AD + VaD). Conclusions: Multispecialty memory clinics combined with a continued focus on diagnostic criteria seem to harmonize the frequency of different dementia diagnoses in-between clinics, although the frequency vascular dementia still varies 8 fold between lowest and highest frequency. The frequency of assigning a (any) specific diagnoses to patients seems to increase. 2009
2010
2011
2012
16
16
6
6
Number of evaluated patients, N 2109 2006 Frequency of dementia 64.3% 61.2% A specific dementia diagnosis Lowest 74% 70% Highest 100% 100%
2094 58.3% 82% 96%
2155 59.8% 81% 96%
Alzheimer’s disease
35% 60% 7% 18% 6% 41%
30% 62% 6% 21% 5% 39%
Number of memory clinics, N
Mixed dementia Vascular dementia
P4-086
Lowest Highest Lowest Highest Lowest Highest
4% 71% 4% 34% 3% 75%
25% 70% 0% 31% 7% 63%
DRAMATIC IMPROVEMENT WITH DONEPEZIL IN A CASE OF DEMENTIA WITH LEWY BODIES
Laura Allen1, Keith Josephs1, Sean Pittock1, Glenn E. Smith1, Robert Ivnik1, Val Lowe1, Bradley Boeve1, 1Mayo Clinic, Rochester, Minnesota, United States. Contact e-mail: [email protected] Background: While improvement is known to occur in DLB patients with cholinesterase inhibitor therapy, few have had detailed neuropsychological and neuroimaging assessments before and after commencement of treatment. Methods: Case Study Results: A 65 year old woman underwent evaluation at our institution after a 16 month history of progressive dementia, visual hallucinations, cognitive fluctuations, daytime hypersomnolence and parkinsonism. Initial exam revealed a Kokmen Short Test of Mental Status (STMS) score of 27/38 and mild parkinsonism. Neuropsychological testing showed a Dementia Rating Scale (DRS) was 126/144, with other measures showing prominent impairment in attention and concentration, processing speed, visuospatial functioning, novel problem solving and encoding of new information. Fluorodeoxyglucose positron emission tomography (FDG-PET) scan of the brain revealed moderately decreased activity in the posterior cingulate, parietal, occipital and frontal lobes with most Z-scores on projection maps being < -2. The features were considered consistent with DLB, and she was commenced on donepezil therapy 10 mg daily. Follow-up assessment 15 months later revealed that within weeks after donepezil treatment there was marked clinical improvement with functional independence. Her STMS score was 35/38. Her scores on neuropsychological assessment were much improved (DRS 139/144), especially in the realms of processing speed and acquisition and retention of data. Her FDG-PET scan findings were also markedly improved, with almost all Z-scores on projection maps being > -1. Conclusions: This case exemplifies the rare but impressive improvement in DLB patients that can occur with cholinesterase inhibitor therapy. P4-087
NUTRITIONAL STATUS AND PROGRESSION OF DEMENTIA: THE CACHE COUNTY DEMENTIA PROGRESSION STUDY
Chelsea Sanders1, Heidi Wengreen1, Christopher Corcoran1, Sarah Schwartz1, Maria Norton1, Constantine Lyketsos2, JoAnn Tschanz1,
P736
Poster Presentations: P4
1 Utah State University, Logan, Utah, United States; 2Johns Hopkins University, Baltimore, Maryland, United States. Contact e-mail: chelsea. [email protected]
30
Background: Few studies have examined nutritional status (i.e. well-nourished, risk for malnutrition, or malnourished), and its association with the progression of dementia after its onset. A large multi-center French study reported that malnourished Alzheimer’s patients declined more rapidly in a one-year follow-up. Here, we investigate the relationship between nutritional status and dementia progression in a U.S. population-based sample. Methods: We assessed 264 individuals with dementia (72% AD, 54% female) annually for up to 7.7 years. Mean (SD) ages of participants were 85.44 (5.60). At baseline and annual follow-ups, cognition was assessed with the Mini-Mental State Exam and functional ability with the Clinical Dementia Rating Sum of Boxes (CDR-sb). Nutritional status was assessed using a modified Mini Nutritional Assessment (mMNA), a well-established questionnaire commonly used to screen and assess malnutrition and risk of malnutrition in older adults. In linear mixed models, we examined change in mMNA over time, and its association with cognitive and functional decline in dementia. Covariates tested in all models included gender, education, dementia type, age of dementia onset, and dementia duration at baseline. Results: mMNA scores declined over time by approximately 0.50 points/year. Worse mMNA scores were associated with female gender, greater dementia onset age and dementia duration, non-AD dementia and worse overall health. Controlling for dementia duration at first visit and presence of 1+ APOE E4 allele, lower mMNA predicted a .10 point/year faster cognitive decline on the MMSE (p ¼ 0.006, ß¼.10). In the functional domain and controlling for dementia duration and dementia type, mMNA was associated with worse (higher) CDR-sb scores. Every 1-unit increase on the mMNA, corresponded to a .44 point higher score on CDR-sb. Conclusions: Assessment of risk for malnutrition is useful in predicting rates of decline in cognitive and functional domains, in persons with dementia. Future research will examine mMNA components that are most predictive of dementia progression.
MNA total
25 20 MMSE 15 10 5 0
2 4 6 Years Since First DPS Visit
8
Figure 1. Decline in MMSE total score in Alzheimer’s disease by mMNA score at the 25th, 50th, and 75th percentiles. P4-088
Background: In patients with dementia, including Alzheimer’s disease (AD), gait and balance disorders have been assessed by the number of falls, balance and gait test scoring, or gait analysis using electronic equipment while walking several meters. However, no study has analyzed gait changes in the daily life of patients with dementia. In this study, we recorded the gait of patients with AD by using a portable gait rhythmograph (PGR) for 24 h and assessed their gait characteristics. Methods: We assessed 14 patients with AD or mild cognitive impairment and 17 cognitively healthy controls. The PGR was attached to the waist of the patient, and the acceleration vector derived from the patient’s movement was recorded for 24 h. The amount of overall movement, mean amplitude of gait acceleration, and mean gait cycle were calculated from the data gathered from each patient during the 24-h period. Cognition was assessed by mini-mental state examination (MMSE). The relationship between cognitive impairment and gait parameters was analyzed by single regression analysis. Results: In patients with AD, the MMSE score showed a weak correlation with the amount of overall movement and mean gait acceleration, indicating that cognitive decline is related to decreased daily activity and floor reaction force. Among the patients with mild cognitive decline, some patients showed slower gait cycle. Conclusions: The main characteristic of the gait in patients with AD is a decrease in the total amount of movement and floor reaction force, which may be related to the instability and falls of AD patients. The slower gait observed in patients with mild cognitive decline may be compensation for gait instability. P4-089
INTERFERENCE OF COGNITIVE DISORDERS IN EVERYDAY LIFE: THE DIAGNOSTIC ACCURACY OF A NEW INSTRUMENTAL ACTIVITIES OF DAILY LIVING INSTRUMENT
Sietske Sikkes1, Yolande Pijnenburg1, Dirk Knol1, Elly de Lange - de Klerk1, Philip Scheltens1, Bernard Uitdehaag1, 1VU University Medical Center, Amsterdam, Netherlands. Contact e-mail: [email protected]
13 16 17.5
0
2 Tokyo Medical and Dental Univiersity, Tokyo, Japan; 3Tokyo Medical University, Tokyo, Japan; 4Tokyo Medical and Dental University Graduate School of Medical and Dental Science, Department of Neu, Tokyo, Japan. Contact e-mail: [email protected]
QUANTITATIVE ANALYSIS OF GAIT DISORDERS IN PEOPLE WITH ALZHEIMER’S DISEASE BY USING A PORTABLE GAIT RHYTHMOGRAPH
Maya Higuma1, Nobuo Sanjo2, Hiroshi Mitoma3, Yoko Ito1, Takumi Hori4, Hidehiro Mizusawa1, 1Tokyo Medical and Dental University, Tokyo, Japan;
Background: An important issue in the clinical diagnosis of dementia is how to quantify the level of interference of cognitive disorders in everyday life. Commonly used informant-based questionnaires aimed at ’instrumental activities of daily living’ (IADL) are generally outdated and have important quality limitations. We recently developed the Amsterdam IADL Questionnaire Ó (AIADL-Q), an instrument aimed at measuring IADL problems in early dementia. In the current study, we set out to investigate the diagnostic accuracy of the A-IADL-Q. Methods: In this prospective diagnostic study, consecutive referrals visiting the Alzheimer center of the VU University Medical center were included (n ¼ 278). Their informants, merely consisting of spouses, completed the A-IADL-Q. Patients were diagnosed using standard clinical diagnostic criteria for dementia (DSM-IV), independently of the A-IADL-Q scores. Diagnostic accuracy was investigated using receiver operating characteristic curves and area under the curves (AUC). An optimal cut-off point for the A-IADL-Q was determined and sensitivity, specificity and likelihood ratios (LR) were calculated for the A-IADL-Q, and the A-IADL-Q in combination with the MMSE. Results: The prevalence of dementia was 50.7%.Patients diagnosed with dementia had lower Amsterdam IADL scores (M¼45.78, SD¼8.30) than patients without dementia (M¼54.48, SD¼9.49), t(276)¼8.14, p<.001. Overall diagnostic accuracy based on the AUC was 0.75 (95%CI: 0.70-0.81) for the A-IADL-Q. The optimal cut-off score for the A-IADL-Q was set at 51.4, resulting in a sensitivity of 0.75 and specificity of 0.66. Combining the A-IADL-Q with the MMSE greatly improved specificity (0.94) and LR+ (9.0) when tests were used in series. Conclusions: In this study, we found a good diagnostic accuracy for A-IADL-Q, which improved further when combined with the MMSE. With a pragmatic approach, we showed that a positive result on both MMSE and A-IADL-Q is a strong indicator of dementia. These results support the role of the A-IADL-Q in diagnosing dementia.