- Email: [email protected]
O1-03-06
S172
Oral O1-03-04: Intervention and Treatments 1
attributes: 17% of the sample was willing to participate in a high risk AD RCT with no amenities; the addition of home visits increased WTP to 27%; low risk, home visits, and a higher chance of the active treatment increased predicted WTP to 60%. The value of home visits correlated well with measures of AD severity (ADL r⫽0.41, p⬍0.001; BADL r⫽0.38, p⬍0.001; NPIQ severity p⫽0.24, p⫽0.01; NPIQ distress r⫽0.23, p⬍0.02), but not with self-reported KI health or burden. Conclusion: RCTs that reduce travel inconvenience may offset the disincentive of study features such as the risk of the intervention and also increase WTP. Redesigning trials may also help recruit patients with more severe AD. Shorter recruitment periods and increased retention rates may offset the costs of these changes. However, further research is needed to see how well predictions from an interview exercise predict in-field behavior. Table 1 Predicted Willingness to Participate by RCT Attributes (Rating Score ⱖ5) Scenario
Predicted willingness to participate
Low risk, home visits, 67-33 drug placebo randomization Low risk, home visits High risk, home visits, 67-33 drug placebo randomization High risk, home visits High risk, 67-33 drug placebo randomization Low risk, no amenities High risk, car service High risk, no amenities (usual AD RCT)
65 (60%)
O1-03-04
51 (47%) 45 (42%) 29 (27%) 27 (25%) 26 (24%) 20 (19%) 18 (17%)
COMPLEMENTARY THERAPIES AND QUALITY OF LIFE RELATIONSHIPS AND DIFFERENCES AMONG RESIDENTS IN A SPECIALIZED DEMENTIA CARE UNIT
Judith C. Drew, Nona Fain, University of Texas Medical Branch, Galveston, TX, USA. Contact e-mail: [email protected] Background: Most types of dementia rob victims of cognitive memory and impair their abilities to function independently and as interactive members of the community. Findings from multiple research studies suggest that dementia sufferers have minimal levels of quality in their lives, yet current medical and pharmacologic interventions have been found to provide little relief. The continuing search for effective approaches to improving the quality of life for persons with dementia must be expanded to include low risk complementary and alternative therapies that the research literature suggests have roles in influencing bio-psycho-social variables in several other patient populations. Objective: The purposes of this single cohort study were to examine: 1) relationships between controlled exposures to aromatherapy, daylight, and music therapy, and SDCU residents’ mood states, nighttime sleep quality, and time spent in activities, and 2) changes in residents’ mood states, nighttime sleep quality, and time spent in activities over time and during controlled exposures of residents to aromatherapy, daylight, and music-focused activities. Methods: Legally responsible parties provided consent for the participation of 25 SDCU residents. Trained staff completed the Proxy-Rated Quality of Life Scale (QOL) (Albert et al., 2001), Signs of Depression Screening Scale (DSS) (Hammond, O’Keefe, & Barer, 2000), and Social Engagement Activities Scale (SEA) (Bassuk, Glass, & Berkman, 1999; Mor et al., 1995) for each subject at baseline, one week, one month, and three months post enrollment. Also recorded were length and quality of nighttime sleep, frequency of daytime napping. Daily logs of subjects’ activities and exposures to aromatherapy, controlled daylight, and music interventions were completed by one research assistant. Results: Statistically significant relationships between pairs of variables (Pearson product-moment) were found for the following conditions: 1) as dose exposures to chamomille and lavender aromatherapies increased, scores on the DSS decreased while levels of contentment (QOL) increased; and 2) as exposures to controlled daylight increased, time spent in daytime napping decreased while time spent in
activities increased. Repeated measures analysis of variance revealed statistically significant changes in DSS, agitation, and QOL over time. Conclusions: Further and more rigorous investigations with comparison groups are needed before findings can be generalized. O1-03-05
SURVIVAL AND MORTALITY DIFFERENCES BETWEEN DEMENTIA WITH LEWY BODIES VERSUS ALZHEIMER DISEASE
James E. Galvin, Monique M. Williams, Chengjie Xiong, John C. Morris, Washington University, St Louis, MO, USA. Contact e-mail: [email protected] Background: Dementia with Lewy bodies (DLB) is a common cause of dementia after Alzheimer disease (AD). Clinical progression of AD is well characterized; however the clinical progression of DLB has not fully been elucidated. There are conflicting reports in the literature regarding disease progression. Objective(s): To determine whether DLB progresses more rapidly than AD to relevant clinical endpoints such as nursing home placement and death. Methods: We compared 315 participants (63 DLB and 252 AD) enrolled in a prospective longitudinal study of memory and aging with annual clinical and cognitive assessments and followed until death. The main outcome measure was dementia progression to institutionalization and death. Neuropathologic examinations were performed on all participants in this study. Subject classification (DLB vs. AD) was based on neuropathology. Results: Patients with DLB had an increased risk of mortality vs. patients with AD (HR 1.88, 95% CI: 1.4-2.5). The median survival time for DLB was 78.0y and for AD was 84.6y (2⫽19.9, p⬍.001) with significant modification effects due to gender (HR 1.51, 95% CI: 1.0-2.3) and the presence of at least 1 ApoE e4 allele (HR 1.50, 95% CI: 1.0-2.2). Survival after dementia onset was also different between DLB and AD (7.3y vs. 8.5y, 2⫽5.4, p⬍.02). DLB cases had similar risks of institutionalization and survival in long term care facilities to AD cases. Self reports of depression and the presence of extrapyramidal signs were important covariates. The rate of cognitive decline as measured by psychometric performance and clinical staging methods did not differ between DLB and AD. Conclusions: Dementia with Lewy bodies increases the risk of mortality compared with AD but the two groups did not differ in rate of cognitive decline. The greater risk for non-cognitive disease progression for DLB compared with AD suggests clinically meaningful differences for the two disorders. O1-03-06
SMALL GROUP HOMES AS “DEMENTIACAPABLE” SETTINGS FOR PEOPLE WITH INTELLECTUAL DISABILITIES AND EARLY STAGE DEMENTIA
Matthew Janicki, University of Illinois at Chicago, Chicago, IL, USA. Contact e-mail: [email protected] Background: Localities are beginning to feel the impact of the growing number of older adults with lifelong intellectual disabilities (ID) who are also affected by dementia. Many local organizations are attempting to adapt their support and residential services to help this group be served more effectively within the community. Yet, questions have been raised as to the models that may most reasonably be used and how to address the discordance between traditional ID service and “dementia-capable” services. Objective: Investigate how localities and organizations have adapted to the onset of dementia and address early stage care demands and determine practices that are effective in promoting “dementia-capable” care. Methods: Several studies were conducted to determine how government entities and local providers are adapting services to identify models prevalent in the provider sector, and specifically to identify staff training needs, physical and environmental adaptations, and differential time spent by staff in providing dementia care. Results: Data showed that most US states are not prepared to address growing onset of dementia in select parts of the ID population, that responses to early stage service needs have been mostly handled by local entities and service organizations, that most have
Oral O1-04-01: Early Detection and Diagnosis 1 not developed extensive training programs for staff and are experimenting with best practice methods to deliver care - primarily via small group homes - and that dementia care takes up a disproportionate amount of staff time in small care settings. Conclusions: To address early stage dementia related services in the most effective manner, a concerted effort needs to be in place to aid local service entities adapt services to dementia-related presentations among ID clientele, set up coordinated training for staff, secure funds for adapting group homes for community “dementia-capable” care, and construction of clinical support services and augmentation of family support services for parents and other kin carers. O1-03-07
INTELLECT IN DEFAULT
Mary J. Flossie, Hiram College, Massillon, OH, USA. Contact e-mail: [email protected] Background: Default mechanisms that surface when intellect fails are human instinct, rote responses, emotional intelligence and autonomic reactions. These keys to human survival are primal and unaffected by disease. Drawing from neuroscience, basic concepts of the limbic system in human development, and applying the psychology of subconscious activity to the primal urges at the core of our human nature, we establish that when one can’t think, one still feels and can interpret interpersonal dynamics with profound accuracy. When the brain is destroyed by disease, intellect will default to instinct by nature. Recognition of what is left well intact leads to new approaches to care and intervention. Objectives: Correlate loss of executive function with enhanced instinctive/reactionary behavior. Recognize behaviors as instinctive human reactions to the environment and interpersonal stimuli. Apply Retro-genesis Theory to formulate effective behavioral interventions. Methods: This workshop hails the “dementia dilemma” from the victim’s perspective by revealing the extent to which behaviors are triggered instinctively by non-verbal, environmental and interpersonal stimuli. Retro-genesis in Alzheimer’s causes developmental regression as the memory of life experiences unravels backward in time, leaving victims with a mental agenda isolated in a previous reality. Results: Defensive and suspicious behaviors are the result of fear, perceived threats, and instinctive reactions to fear, over which victims of dementia have no control. Lack of intellectual counterbalance, which is at the core of “seemingly” unreasonable activity, co-exists with Retro-genesis and must be considered in conjunction with autonomic responses if effective “interventions” are to be formulated. Conclusions: Care focus becomes blurred by unrelenting tasks that have to be managed with the cooperation of the confused. Well intended efforts become undermined by personal feelings of exasperation, grief and failure in the process. The obvious is overlooked because intellect itself contradicts understanding dementia. Much can be done to secure, comfort and minimize the fear and anxiety that leads to disturbances if one understands the true underlying causes and abandons dependence on language and learned expectations. Integrating diversity of knowledge equips carers toward improving the quality of life for the compromised as well as themselves. O1-03-08
COMMUNICATION THROUGH MUSIC
Steven Toll1,2, 1Columbia University, New York, NY, USA; 2 Prescription-Music, Surf City, NC, USA. Contact e-mail: [email protected] We have been working with patients in assisted living facilities and senior centers for the past five years and have been documenting our observations. We have successfully stimulated a higher level of communication when music is part of the daily treatment plan. Through the use of historical data about the individual patients which we gather from the institution and patient’s family we are able to construct a musical program which is tailored to the patient’s preferences and taps into long term memories. By stimulating long term memories we increase the level of socialization with other patients, staff and the facilitator, which creates a higher level of communication. We have observed heightened concentration and ability to focus, decreased levels of agitation and general improved quality of life.
S173
We believe that daily therapeutic music programs have the potential to create a higher level of communication between patients and caregivers and improve their quality of life. SUNDAY, JUNE 10, 2007 ORAL O1-04 EARLY DETECTION AND DIAGNOSIS 1 O1-04-01
QUANTITATIVE EVALUATION OF PIB PET AND FDG PET IN EARLY COGNITIVE IMPAIRMENT
Val J. Lowe1, Brad Kemp1, Clifford R. Jack1, Chester A. Mathis2, William E. Klunk2, Ronald Petersen1, 1Mayo Clinic, Rochester, MN, USA; 2University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Contact e-mail: [email protected] Objective: To evaluate the comparative accuracy of PIB PET and FDG PET in subjects with early symptoms of cognitive impairment. Background: Quantification of PIB (Pittsburgh Compound-B) PET in dementia has shown marked differences between normal (N) and AD subjects. Less clear is its ability to characterize patients with early cognitive impairment as seen in mild cognitive impairment (MCI) or very mild AD subjects. Scant data has been published of PIB PET and FDG PET in these subjects. In this study we compared the ability of PIB PET and FDG PET to characterize patients with limited cognitive impairment to age-matched normal controls. Methods: Ten normal (N) and 12 subjects with some limited degree of cognitive impairment (MCI (N⫽6, CDR 0.5) or very mild AD (N⫽6, CDR 0.5 or 1.0)) were enrolled. Ratios of activity in frontal, posterior cingulate, temporal and parietal cortical regions to cerebellum were obtained on PIB images. Ratios of activity from posterior cingulate, temporal and parietal regions to pons were obtained on FDG images. Averaged activity ratios (AR) for each patient were obtained and a cutoff of 1.35 was used. PIB AR above 1.35 were considered positive and FDG AR below 1.35 were considered positive for cognitive impairment. Results: The sensitivity and specificity for detection of some cognitive impairment was 83% (10/12) and 90% (9/10) for PIB PET and 92% (11/12) and 100% (10/10) for FDG PET respectively. Mean (SD) AR for PIB were 1.77 (0.32), in those with cognitive impairment (1.68 (0.28) in MCI and 1.85 (0.37) in AD) and 1.14 (0.12) in normals. Mean (SD) AR for FDG were 1.27 (0.09) in those with cognitive impairment (1.30 (0.03) in MCI and 1.23 (0.12) in AD) and 1.45 (0.1) in normals. Conclusions: Similar accuracy in characterization of patients with early symptoms of cognitive impairment and normal subjects was seen using PIB PET or FDG PET. O1-04-02
INITIAL RESULTS FROM HUMAN STUDIES OF A NOVEL F-18 PET LIGAND FOR BRAIN BETAAMYLOID IMAGING
Christopher C. Rowe1, Steven Ng1, Rachel S. Mulligan1, Uwe Ackermann1, William Browne1, Graeme O’Keefe1, Henri J. Tochon-Danguy1, Gordon Chan1, Hank F. Kung2, Mei-Ping Kung2, Daniel M. Skovronsky3, Thomas Dyrks4, Gerhard Holl4, Sabine Krause4, Matthias Friebe4, Stefanie Lindemann4, Wolf Sittner4, Ludger M. Dinkelborg4, Colin L. Masters5,6, Victor L. Villemagne1,5, 1Austin Hospital, Melbourne, VIC, Australia; 2 University of Pennsylvania, Philadelphia, PA, USA; 3Avid Radiopharmaceuticals, Inc., Philadelphia, PA, USA; 4Bayer Schering Pharma AG, Berlin, Germany; 5University of Melbourne, Melbourne, VIC, Australia; 6The Mental Health Research Institute of Victoria, Melbourne, VIC, Australia. Contact e-mail: [email protected] Background: 11C-PIB PET has proven useful for the detection of betaamyloid (A) in vivo in Alzheimer’s disease. However, the 20-minute half-life of C-11 restricts the use of PIB to centers with an on-site cyclotron. Objective: The aim of this study was to assess the lead compound from a novel series of F-18 labelled amyloid imaging ligands in AD
Oral O1-03-04: Intervention and Treatments 1
attributes: 17% of the sample was willing to participate in a high risk AD RCT with no amenities; the addition of home visits increased WTP to 27%; low risk, home visits, and a higher chance of the active treatment increased predicted WTP to 60%. The value of home visits correlated well with measures of AD severity (ADL r⫽0.41, p⬍0.001; BADL r⫽0.38, p⬍0.001; NPIQ severity p⫽0.24, p⫽0.01; NPIQ distress r⫽0.23, p⬍0.02), but not with self-reported KI health or burden. Conclusion: RCTs that reduce travel inconvenience may offset the disincentive of study features such as the risk of the intervention and also increase WTP. Redesigning trials may also help recruit patients with more severe AD. Shorter recruitment periods and increased retention rates may offset the costs of these changes. However, further research is needed to see how well predictions from an interview exercise predict in-field behavior. Table 1 Predicted Willingness to Participate by RCT Attributes (Rating Score ⱖ5) Scenario
Predicted willingness to participate
Low risk, home visits, 67-33 drug placebo randomization Low risk, home visits High risk, home visits, 67-33 drug placebo randomization High risk, home visits High risk, 67-33 drug placebo randomization Low risk, no amenities High risk, car service High risk, no amenities (usual AD RCT)
65 (60%)
O1-03-04
51 (47%) 45 (42%) 29 (27%) 27 (25%) 26 (24%) 20 (19%) 18 (17%)
COMPLEMENTARY THERAPIES AND QUALITY OF LIFE RELATIONSHIPS AND DIFFERENCES AMONG RESIDENTS IN A SPECIALIZED DEMENTIA CARE UNIT
Judith C. Drew, Nona Fain, University of Texas Medical Branch, Galveston, TX, USA. Contact e-mail: [email protected] Background: Most types of dementia rob victims of cognitive memory and impair their abilities to function independently and as interactive members of the community. Findings from multiple research studies suggest that dementia sufferers have minimal levels of quality in their lives, yet current medical and pharmacologic interventions have been found to provide little relief. The continuing search for effective approaches to improving the quality of life for persons with dementia must be expanded to include low risk complementary and alternative therapies that the research literature suggests have roles in influencing bio-psycho-social variables in several other patient populations. Objective: The purposes of this single cohort study were to examine: 1) relationships between controlled exposures to aromatherapy, daylight, and music therapy, and SDCU residents’ mood states, nighttime sleep quality, and time spent in activities, and 2) changes in residents’ mood states, nighttime sleep quality, and time spent in activities over time and during controlled exposures of residents to aromatherapy, daylight, and music-focused activities. Methods: Legally responsible parties provided consent for the participation of 25 SDCU residents. Trained staff completed the Proxy-Rated Quality of Life Scale (QOL) (Albert et al., 2001), Signs of Depression Screening Scale (DSS) (Hammond, O’Keefe, & Barer, 2000), and Social Engagement Activities Scale (SEA) (Bassuk, Glass, & Berkman, 1999; Mor et al., 1995) for each subject at baseline, one week, one month, and three months post enrollment. Also recorded were length and quality of nighttime sleep, frequency of daytime napping. Daily logs of subjects’ activities and exposures to aromatherapy, controlled daylight, and music interventions were completed by one research assistant. Results: Statistically significant relationships between pairs of variables (Pearson product-moment) were found for the following conditions: 1) as dose exposures to chamomille and lavender aromatherapies increased, scores on the DSS decreased while levels of contentment (QOL) increased; and 2) as exposures to controlled daylight increased, time spent in daytime napping decreased while time spent in
activities increased. Repeated measures analysis of variance revealed statistically significant changes in DSS, agitation, and QOL over time. Conclusions: Further and more rigorous investigations with comparison groups are needed before findings can be generalized. O1-03-05
SURVIVAL AND MORTALITY DIFFERENCES BETWEEN DEMENTIA WITH LEWY BODIES VERSUS ALZHEIMER DISEASE
James E. Galvin, Monique M. Williams, Chengjie Xiong, John C. Morris, Washington University, St Louis, MO, USA. Contact e-mail: [email protected] Background: Dementia with Lewy bodies (DLB) is a common cause of dementia after Alzheimer disease (AD). Clinical progression of AD is well characterized; however the clinical progression of DLB has not fully been elucidated. There are conflicting reports in the literature regarding disease progression. Objective(s): To determine whether DLB progresses more rapidly than AD to relevant clinical endpoints such as nursing home placement and death. Methods: We compared 315 participants (63 DLB and 252 AD) enrolled in a prospective longitudinal study of memory and aging with annual clinical and cognitive assessments and followed until death. The main outcome measure was dementia progression to institutionalization and death. Neuropathologic examinations were performed on all participants in this study. Subject classification (DLB vs. AD) was based on neuropathology. Results: Patients with DLB had an increased risk of mortality vs. patients with AD (HR 1.88, 95% CI: 1.4-2.5). The median survival time for DLB was 78.0y and for AD was 84.6y (2⫽19.9, p⬍.001) with significant modification effects due to gender (HR 1.51, 95% CI: 1.0-2.3) and the presence of at least 1 ApoE e4 allele (HR 1.50, 95% CI: 1.0-2.2). Survival after dementia onset was also different between DLB and AD (7.3y vs. 8.5y, 2⫽5.4, p⬍.02). DLB cases had similar risks of institutionalization and survival in long term care facilities to AD cases. Self reports of depression and the presence of extrapyramidal signs were important covariates. The rate of cognitive decline as measured by psychometric performance and clinical staging methods did not differ between DLB and AD. Conclusions: Dementia with Lewy bodies increases the risk of mortality compared with AD but the two groups did not differ in rate of cognitive decline. The greater risk for non-cognitive disease progression for DLB compared with AD suggests clinically meaningful differences for the two disorders. O1-03-06
SMALL GROUP HOMES AS “DEMENTIACAPABLE” SETTINGS FOR PEOPLE WITH INTELLECTUAL DISABILITIES AND EARLY STAGE DEMENTIA
Matthew Janicki, University of Illinois at Chicago, Chicago, IL, USA. Contact e-mail: [email protected] Background: Localities are beginning to feel the impact of the growing number of older adults with lifelong intellectual disabilities (ID) who are also affected by dementia. Many local organizations are attempting to adapt their support and residential services to help this group be served more effectively within the community. Yet, questions have been raised as to the models that may most reasonably be used and how to address the discordance between traditional ID service and “dementia-capable” services. Objective: Investigate how localities and organizations have adapted to the onset of dementia and address early stage care demands and determine practices that are effective in promoting “dementia-capable” care. Methods: Several studies were conducted to determine how government entities and local providers are adapting services to identify models prevalent in the provider sector, and specifically to identify staff training needs, physical and environmental adaptations, and differential time spent by staff in providing dementia care. Results: Data showed that most US states are not prepared to address growing onset of dementia in select parts of the ID population, that responses to early stage service needs have been mostly handled by local entities and service organizations, that most have
Oral O1-04-01: Early Detection and Diagnosis 1 not developed extensive training programs for staff and are experimenting with best practice methods to deliver care - primarily via small group homes - and that dementia care takes up a disproportionate amount of staff time in small care settings. Conclusions: To address early stage dementia related services in the most effective manner, a concerted effort needs to be in place to aid local service entities adapt services to dementia-related presentations among ID clientele, set up coordinated training for staff, secure funds for adapting group homes for community “dementia-capable” care, and construction of clinical support services and augmentation of family support services for parents and other kin carers. O1-03-07
INTELLECT IN DEFAULT
Mary J. Flossie, Hiram College, Massillon, OH, USA. Contact e-mail: [email protected] Background: Default mechanisms that surface when intellect fails are human instinct, rote responses, emotional intelligence and autonomic reactions. These keys to human survival are primal and unaffected by disease. Drawing from neuroscience, basic concepts of the limbic system in human development, and applying the psychology of subconscious activity to the primal urges at the core of our human nature, we establish that when one can’t think, one still feels and can interpret interpersonal dynamics with profound accuracy. When the brain is destroyed by disease, intellect will default to instinct by nature. Recognition of what is left well intact leads to new approaches to care and intervention. Objectives: Correlate loss of executive function with enhanced instinctive/reactionary behavior. Recognize behaviors as instinctive human reactions to the environment and interpersonal stimuli. Apply Retro-genesis Theory to formulate effective behavioral interventions. Methods: This workshop hails the “dementia dilemma” from the victim’s perspective by revealing the extent to which behaviors are triggered instinctively by non-verbal, environmental and interpersonal stimuli. Retro-genesis in Alzheimer’s causes developmental regression as the memory of life experiences unravels backward in time, leaving victims with a mental agenda isolated in a previous reality. Results: Defensive and suspicious behaviors are the result of fear, perceived threats, and instinctive reactions to fear, over which victims of dementia have no control. Lack of intellectual counterbalance, which is at the core of “seemingly” unreasonable activity, co-exists with Retro-genesis and must be considered in conjunction with autonomic responses if effective “interventions” are to be formulated. Conclusions: Care focus becomes blurred by unrelenting tasks that have to be managed with the cooperation of the confused. Well intended efforts become undermined by personal feelings of exasperation, grief and failure in the process. The obvious is overlooked because intellect itself contradicts understanding dementia. Much can be done to secure, comfort and minimize the fear and anxiety that leads to disturbances if one understands the true underlying causes and abandons dependence on language and learned expectations. Integrating diversity of knowledge equips carers toward improving the quality of life for the compromised as well as themselves. O1-03-08
COMMUNICATION THROUGH MUSIC
Steven Toll1,2, 1Columbia University, New York, NY, USA; 2 Prescription-Music, Surf City, NC, USA. Contact e-mail: [email protected] We have been working with patients in assisted living facilities and senior centers for the past five years and have been documenting our observations. We have successfully stimulated a higher level of communication when music is part of the daily treatment plan. Through the use of historical data about the individual patients which we gather from the institution and patient’s family we are able to construct a musical program which is tailored to the patient’s preferences and taps into long term memories. By stimulating long term memories we increase the level of socialization with other patients, staff and the facilitator, which creates a higher level of communication. We have observed heightened concentration and ability to focus, decreased levels of agitation and general improved quality of life.
S173
We believe that daily therapeutic music programs have the potential to create a higher level of communication between patients and caregivers and improve their quality of life. SUNDAY, JUNE 10, 2007 ORAL O1-04 EARLY DETECTION AND DIAGNOSIS 1 O1-04-01
QUANTITATIVE EVALUATION OF PIB PET AND FDG PET IN EARLY COGNITIVE IMPAIRMENT
Val J. Lowe1, Brad Kemp1, Clifford R. Jack1, Chester A. Mathis2, William E. Klunk2, Ronald Petersen1, 1Mayo Clinic, Rochester, MN, USA; 2University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Contact e-mail: [email protected] Objective: To evaluate the comparative accuracy of PIB PET and FDG PET in subjects with early symptoms of cognitive impairment. Background: Quantification of PIB (Pittsburgh Compound-B) PET in dementia has shown marked differences between normal (N) and AD subjects. Less clear is its ability to characterize patients with early cognitive impairment as seen in mild cognitive impairment (MCI) or very mild AD subjects. Scant data has been published of PIB PET and FDG PET in these subjects. In this study we compared the ability of PIB PET and FDG PET to characterize patients with limited cognitive impairment to age-matched normal controls. Methods: Ten normal (N) and 12 subjects with some limited degree of cognitive impairment (MCI (N⫽6, CDR 0.5) or very mild AD (N⫽6, CDR 0.5 or 1.0)) were enrolled. Ratios of activity in frontal, posterior cingulate, temporal and parietal cortical regions to cerebellum were obtained on PIB images. Ratios of activity from posterior cingulate, temporal and parietal regions to pons were obtained on FDG images. Averaged activity ratios (AR) for each patient were obtained and a cutoff of 1.35 was used. PIB AR above 1.35 were considered positive and FDG AR below 1.35 were considered positive for cognitive impairment. Results: The sensitivity and specificity for detection of some cognitive impairment was 83% (10/12) and 90% (9/10) for PIB PET and 92% (11/12) and 100% (10/10) for FDG PET respectively. Mean (SD) AR for PIB were 1.77 (0.32), in those with cognitive impairment (1.68 (0.28) in MCI and 1.85 (0.37) in AD) and 1.14 (0.12) in normals. Mean (SD) AR for FDG were 1.27 (0.09) in those with cognitive impairment (1.30 (0.03) in MCI and 1.23 (0.12) in AD) and 1.45 (0.1) in normals. Conclusions: Similar accuracy in characterization of patients with early symptoms of cognitive impairment and normal subjects was seen using PIB PET or FDG PET. O1-04-02
INITIAL RESULTS FROM HUMAN STUDIES OF A NOVEL F-18 PET LIGAND FOR BRAIN BETAAMYLOID IMAGING
Christopher C. Rowe1, Steven Ng1, Rachel S. Mulligan1, Uwe Ackermann1, William Browne1, Graeme O’Keefe1, Henri J. Tochon-Danguy1, Gordon Chan1, Hank F. Kung2, Mei-Ping Kung2, Daniel M. Skovronsky3, Thomas Dyrks4, Gerhard Holl4, Sabine Krause4, Matthias Friebe4, Stefanie Lindemann4, Wolf Sittner4, Ludger M. Dinkelborg4, Colin L. Masters5,6, Victor L. Villemagne1,5, 1Austin Hospital, Melbourne, VIC, Australia; 2 University of Pennsylvania, Philadelphia, PA, USA; 3Avid Radiopharmaceuticals, Inc., Philadelphia, PA, USA; 4Bayer Schering Pharma AG, Berlin, Germany; 5University of Melbourne, Melbourne, VIC, Australia; 6The Mental Health Research Institute of Victoria, Melbourne, VIC, Australia. Contact e-mail: [email protected] Background: 11C-PIB PET has proven useful for the detection of betaamyloid (A) in vivo in Alzheimer’s disease. However, the 20-minute half-life of C-11 restricts the use of PIB to centers with an on-site cyclotron. Objective: The aim of this study was to assess the lead compound from a novel series of F-18 labelled amyloid imaging ligands in AD