- Email: [email protected]
O2-01-05: Ubiquity and utility of subjective cognitive complaints
Oral O2-01: Diagnosis and Clinical Course: Clinical Research Individuals With Incident Dementia, Shown by Prior Cognitive Status Incident dementia type
Prior aMCI/prAD
All-cause dementia AD
31(41.3%) 29(45.3%)
*
Other CIND
*
16(21.3%) 13(20.3%)
No CIND
*
28(37.3%) 22(34.4%)
*Numbers with (percent). 75 cases of incident dementia diagnosed by DSM-III-R criteria, 64 with AD diagnosed by NINCDS-ADRDA criteria.
Conclusions: These findings suggest that: 1) in the longitudinal study of large samples, aMCI and prAD are poor predictors of subsequent dementia; and 2) a surprising proportion of individuals with incident dementia appear to have developed their symptoms after a very brief or undetected stage of prior cognitive impairment. Provided sufficient numbers are available, the characteristics of the latter group deserve close inquiry. O2-01-03
IS MILD COGNITIVE IMPAIRMENT A STABLE DIAGNOSTIC ENTITY?
Lia M. A. E. Baars, Martin P. J. van Boxtel, Pieter Jelle Visser, Frans R. J. Verhey, Jelle Jolles, Maastricht University, Maastricht, Netherlands. Contact e-mail: [email protected] Background: Transition from MCI to normal functioning is one main longitudinal outcome for MCI cases. This raises questions about the usability of the concept MCI as a clinical entity. It remains unclear to what extent effects of practice on neuropsychological test performance could explain the instability of MCI diagnosis over time, depending on the definition of MCI used. The aim of this study was to investigate the stability of MCI over time in a large population-based sample, by comparing different methods of measuring MCI stability. Methods: Data were taken from the Maastricht Aging Study, a large longitudinal study into the determinants of cognitive aging (Jolles, Houx et al. 1995). MCI was defined as impaired memory functioning (a score of at least 1.5 SD below the mean on at least one memory task), no dementia and normal ADL functioning. Three methods of stability were compared: M1 used the baseline MCI cut-off for the 3 and 6 years follow up (FU). For method M2, the MCI cut-off was calculated for each FU separately and in method M3, effects of practice for MCI cases were corrected for practice effects of healthy controls. Only participants of 60 years and older who completed three measurements were included in the current study (N⫽420). Results: 30 MCI cases were identified at baseline. For method M1 33.3% were still case at 3 years FU, and 56.7% were case after 6 years. With method M2, 40% were still case 3 years after baseline and 56.7% at 6 years FU. Method M3 showed a different pattern, with 13.3% stable MCI cases in the first 3 years and 56.7% after 6 years. Conclusions: MCI was found to be an instable condition over time, regardless of the definition used. In MAAS, MCI defined at baseline was the strongest predictor for dementia. The pattern of instability was indicative of regression-to-the-mean and should not be misinterpreted as being evidence for instability of prodromal cognitive disorders, but should be considered a consequence of using behavioural measures sensitive to learning effects to define them. These findings challenge the usefulness of the MCI concept in epidemiological studies. O2-01-04
CEREBROVASCULAR DISEASE IN MILD COGNITIVE IMPAIRMENT
Jose´ A. Luchsinger1, Adam M. Brickman1, Christiane Reitz1, Nicole Schupf1, Jennifer J. Manly1, Ming X. Tang1, Scott A. Small1, Richard Mayeux1, Charles DeCarli2, Truman R. Brown1, 1Columbia University, New York, NY, USA; 2UC-Davis, Davis, CA, USA. Contact e-mail: [email protected] Background: Cerebrovascular disease (CVD) is the main cause of vascular cognitive impairment and may be important in Alzheimer’s disease (AD). Mild cognitive impairment (MCI) is a transitional stage between normal cognition and dementia. Amnestic MCI (AMCI) is thought to be a transitional stage of Alzheimer’s disease (AD), while non-amnestic MCI (NAMCI) may be related to other causes including CVD. Objectives: We
T131
sought to determine the cross-sectional relation of white matter hyperintensity volume (WMH) and infarcts in brain magnetic resonance imaging (MRI) with MCI. Methods: 679 elderly persons aged 80.0 ⫾ 5.6 years (67.6% women, 34.9% African American, 36.1% Hispanic, 29.0% White) without dementia and with MCI information underwent brain MRI. WMH and infarcts (ⱖ 3 mm) were quantified using standard research methods. WMH was adjusted for total cranial volume (TCV). WMH distribution was highly skewed and required logarithmic transformation. The definition of MCI was similar to the Petersen criteria. MCI was sub-classified into AMCI and NAMCI. We estimated odds ratios (OR) and 95% confidence intervals (CI) using logistic regression. Results: The prevalence of MCI was 25.2% (14.3% AMCI, 10.9% NAMCI). On average, 1.2 ⫾ 1.2 % of the TCV was occupied by WMH; 30.1% of the participants had infarcts on MRI. WMH was associated with AMCI (OR⫽1.9; 95% CI: 1,3.1) but not NAMCI (OR ⫽ 1.0; 95% CI: 0.6,1.8) after adjusting for demographics, APOE-⑀4, vascular risk factors, and infarcts. Presence of infarcts was strongly associated with NAMCI (OR ⫽2.6; 95% CI: 1.4,4.6) but not with AMCI (OR⫽1.2; 95% CI: 0.7,2.1) adjusting for demographics, APOE-⑀4, vascular risk factors, and WMH. Results were similar when quartiles of WMH were examined. Frontal lobe infarcts were significantly related to a higher risk of NAMCI. Conclusions: WMH was specifically related to AMCI, supporting previous studies relating WMH to AD. Infarcts were specifically related to NAMCI. The nature and mechanism of WMH in AMCI requires further study. O2-01-05
UBIQUITY AND UTILITY OF SUBJECTIVE COGNITIVE COMPLAINTS
Henry Brodaty1, Perminder Sachdev2, Melissa Slavin2, Nicole Kochan2, Julian Trollor2, Brian Draper3, Tony Broe4, 1Dementia Collaborative Research Centre, University of New South Wales, Sydney, NSW, Australia; 2Brain Ageing Program, University of New South Wales, Randwick, NSW, Australia; 3Aged Care Psychiatry, Prince of Wales Hospital, Randwick, NSW, Australia; 4Medical Research Institute, University of New South Wales, Randwick, NSW, Australia. Contact email: [email protected] Background: We examined the construct of Subjective Cognitive Complaints (SCCs). Cognitive complaint, whether it relate to memory or another cognitive domain or emanate from individuals or informants is one criterion required for the diagnosis of Mild Cognitive Impairment (MCI). Yet SCC remains ill-defined. We posed several questions: What is the prevalence of SCCs as variously defined? What are the implications of complaints by a person versus by an informant? Spontaneous complaints versus responses to questions versus treatment seeking? Memory versus other cognitive complaints? How accurately do SCCs correspond to neuropsychological performance? How useful are SCCs for diagnosing MCI? Methods: Over 1000 community dwelling Sydney-siders, aged 70-90 years were recruited from the Australian Electoral Roll, where voting is compulsory. Comprehensive assessments included structured interviews, the MAC-Q, a battery of neuropsychological tests and informant interviews. Exclusion criteria included dementia, serious health problems and alcohol dependence. We present the results of the first 700 ratings of subjective and informant complaints regarding memory, language, visuospatial skills and executive functions and correlations with performance on corresponding tests. Cognitive impairment was defined as 1.5 standard deviations or more below normal for age and education. Results: 93% of participants and 74% of informants noted at least one cognitive complaint. Almost all participants (91%) corroborated informants’ complaints but only 61% of informants agreed with participants’ reports of SCCs. As regards objective performance, 58% of participants had no impairment, and 14% had memory single domain, 10% memory multiple domain, 15% non-memory single domain, and 3% non-memory multiple domain impairment. There were almost no significant correlations of memory or other cognitive complaints by subject or informant with relevant objective performance. Exceptions were memory and non-memory multiple domain impairment were both associated with seeing a doctor and visuo-spatial
Prior aMCI/prAD
All-cause dementia AD
31(41.3%) 29(45.3%)
*
Other CIND
*
16(21.3%) 13(20.3%)
No CIND
*
28(37.3%) 22(34.4%)
*Numbers with (percent). 75 cases of incident dementia diagnosed by DSM-III-R criteria, 64 with AD diagnosed by NINCDS-ADRDA criteria.
Conclusions: These findings suggest that: 1) in the longitudinal study of large samples, aMCI and prAD are poor predictors of subsequent dementia; and 2) a surprising proportion of individuals with incident dementia appear to have developed their symptoms after a very brief or undetected stage of prior cognitive impairment. Provided sufficient numbers are available, the characteristics of the latter group deserve close inquiry. O2-01-03
IS MILD COGNITIVE IMPAIRMENT A STABLE DIAGNOSTIC ENTITY?
Lia M. A. E. Baars, Martin P. J. van Boxtel, Pieter Jelle Visser, Frans R. J. Verhey, Jelle Jolles, Maastricht University, Maastricht, Netherlands. Contact e-mail: [email protected] Background: Transition from MCI to normal functioning is one main longitudinal outcome for MCI cases. This raises questions about the usability of the concept MCI as a clinical entity. It remains unclear to what extent effects of practice on neuropsychological test performance could explain the instability of MCI diagnosis over time, depending on the definition of MCI used. The aim of this study was to investigate the stability of MCI over time in a large population-based sample, by comparing different methods of measuring MCI stability. Methods: Data were taken from the Maastricht Aging Study, a large longitudinal study into the determinants of cognitive aging (Jolles, Houx et al. 1995). MCI was defined as impaired memory functioning (a score of at least 1.5 SD below the mean on at least one memory task), no dementia and normal ADL functioning. Three methods of stability were compared: M1 used the baseline MCI cut-off for the 3 and 6 years follow up (FU). For method M2, the MCI cut-off was calculated for each FU separately and in method M3, effects of practice for MCI cases were corrected for practice effects of healthy controls. Only participants of 60 years and older who completed three measurements were included in the current study (N⫽420). Results: 30 MCI cases were identified at baseline. For method M1 33.3% were still case at 3 years FU, and 56.7% were case after 6 years. With method M2, 40% were still case 3 years after baseline and 56.7% at 6 years FU. Method M3 showed a different pattern, with 13.3% stable MCI cases in the first 3 years and 56.7% after 6 years. Conclusions: MCI was found to be an instable condition over time, regardless of the definition used. In MAAS, MCI defined at baseline was the strongest predictor for dementia. The pattern of instability was indicative of regression-to-the-mean and should not be misinterpreted as being evidence for instability of prodromal cognitive disorders, but should be considered a consequence of using behavioural measures sensitive to learning effects to define them. These findings challenge the usefulness of the MCI concept in epidemiological studies. O2-01-04
CEREBROVASCULAR DISEASE IN MILD COGNITIVE IMPAIRMENT
Jose´ A. Luchsinger1, Adam M. Brickman1, Christiane Reitz1, Nicole Schupf1, Jennifer J. Manly1, Ming X. Tang1, Scott A. Small1, Richard Mayeux1, Charles DeCarli2, Truman R. Brown1, 1Columbia University, New York, NY, USA; 2UC-Davis, Davis, CA, USA. Contact e-mail: [email protected] Background: Cerebrovascular disease (CVD) is the main cause of vascular cognitive impairment and may be important in Alzheimer’s disease (AD). Mild cognitive impairment (MCI) is a transitional stage between normal cognition and dementia. Amnestic MCI (AMCI) is thought to be a transitional stage of Alzheimer’s disease (AD), while non-amnestic MCI (NAMCI) may be related to other causes including CVD. Objectives: We
T131
sought to determine the cross-sectional relation of white matter hyperintensity volume (WMH) and infarcts in brain magnetic resonance imaging (MRI) with MCI. Methods: 679 elderly persons aged 80.0 ⫾ 5.6 years (67.6% women, 34.9% African American, 36.1% Hispanic, 29.0% White) without dementia and with MCI information underwent brain MRI. WMH and infarcts (ⱖ 3 mm) were quantified using standard research methods. WMH was adjusted for total cranial volume (TCV). WMH distribution was highly skewed and required logarithmic transformation. The definition of MCI was similar to the Petersen criteria. MCI was sub-classified into AMCI and NAMCI. We estimated odds ratios (OR) and 95% confidence intervals (CI) using logistic regression. Results: The prevalence of MCI was 25.2% (14.3% AMCI, 10.9% NAMCI). On average, 1.2 ⫾ 1.2 % of the TCV was occupied by WMH; 30.1% of the participants had infarcts on MRI. WMH was associated with AMCI (OR⫽1.9; 95% CI: 1,3.1) but not NAMCI (OR ⫽ 1.0; 95% CI: 0.6,1.8) after adjusting for demographics, APOE-⑀4, vascular risk factors, and infarcts. Presence of infarcts was strongly associated with NAMCI (OR ⫽2.6; 95% CI: 1.4,4.6) but not with AMCI (OR⫽1.2; 95% CI: 0.7,2.1) adjusting for demographics, APOE-⑀4, vascular risk factors, and WMH. Results were similar when quartiles of WMH were examined. Frontal lobe infarcts were significantly related to a higher risk of NAMCI. Conclusions: WMH was specifically related to AMCI, supporting previous studies relating WMH to AD. Infarcts were specifically related to NAMCI. The nature and mechanism of WMH in AMCI requires further study. O2-01-05
UBIQUITY AND UTILITY OF SUBJECTIVE COGNITIVE COMPLAINTS
Henry Brodaty1, Perminder Sachdev2, Melissa Slavin2, Nicole Kochan2, Julian Trollor2, Brian Draper3, Tony Broe4, 1Dementia Collaborative Research Centre, University of New South Wales, Sydney, NSW, Australia; 2Brain Ageing Program, University of New South Wales, Randwick, NSW, Australia; 3Aged Care Psychiatry, Prince of Wales Hospital, Randwick, NSW, Australia; 4Medical Research Institute, University of New South Wales, Randwick, NSW, Australia. Contact email: [email protected] Background: We examined the construct of Subjective Cognitive Complaints (SCCs). Cognitive complaint, whether it relate to memory or another cognitive domain or emanate from individuals or informants is one criterion required for the diagnosis of Mild Cognitive Impairment (MCI). Yet SCC remains ill-defined. We posed several questions: What is the prevalence of SCCs as variously defined? What are the implications of complaints by a person versus by an informant? Spontaneous complaints versus responses to questions versus treatment seeking? Memory versus other cognitive complaints? How accurately do SCCs correspond to neuropsychological performance? How useful are SCCs for diagnosing MCI? Methods: Over 1000 community dwelling Sydney-siders, aged 70-90 years were recruited from the Australian Electoral Roll, where voting is compulsory. Comprehensive assessments included structured interviews, the MAC-Q, a battery of neuropsychological tests and informant interviews. Exclusion criteria included dementia, serious health problems and alcohol dependence. We present the results of the first 700 ratings of subjective and informant complaints regarding memory, language, visuospatial skills and executive functions and correlations with performance on corresponding tests. Cognitive impairment was defined as 1.5 standard deviations or more below normal for age and education. Results: 93% of participants and 74% of informants noted at least one cognitive complaint. Almost all participants (91%) corroborated informants’ complaints but only 61% of informants agreed with participants’ reports of SCCs. As regards objective performance, 58% of participants had no impairment, and 14% had memory single domain, 10% memory multiple domain, 15% non-memory single domain, and 3% non-memory multiple domain impairment. There were almost no significant correlations of memory or other cognitive complaints by subject or informant with relevant objective performance. Exceptions were memory and non-memory multiple domain impairment were both associated with seeing a doctor and visuo-spatial