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P-057: Association between left ventricular diastolic function and cognitive performance in adults with Down syndrome
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
objectives, level of cognitive functionality, or guided neuropsychological exploring. We have designed a telerehabilitation innovative system that faces the clinical and technological challenges. Method: The initial and final evaluations have been carried out after an intervention period of 6 months. The target population was 115 persons at the beginning and 63 at the end, from which 25 (X=81, 38 years) lived in elderly population residences and 38 (X=77, 13 years) in the community. The cognitive profile was classified in 4 levels. The satisfaction was evaluated with validated questionnaires analyze telemedicine programs according to the Model for Assessment of Telemedicine Application and the levels of life quality according to the health questionnaire EUROQOL 5D. Results: The average cognitive level of the residential population was 1.72 and in the community, 2.50. The final level was 1.80 and 2.47, respectively. The satisfaction degree was considered to be excellent in 60% and good in 40%. The tool was considered to be recommendable in 80%. In the life quality of the residential population, 68% had a mobility issue, and 42% presented pain; meanwhile, in the communal population, 33% had a mobility issue and 42% presented pain. Conclusions: • Excellent acceptance of the tool • Usefulness of the tool to increase the life quality, without affecting the self-care • Decelerate the cognitive impairment in residential population. Minor improvement. P-057 Association between left ventricular diastolic function and cognitive performance in adults with Down syndrome A. Carfì1 , D.L. Vetrano2 , V. Brandi2 , F. Fiore1 , D. Mascia1 , S. Di Tella1 , R. Bernabei2 , G. Onder2 1 Department of Geriatrics – Catholic University of the Sacred Heart, Rome, Italy; 2 Italy Objectives: Down syndrome(DS) is characterized by high rates of early-onset age-related disorders and in particular persons with this condition are at high risk of experiencing Alzheimer disease(AD). Subjects with DS are also known for very low prevalence rates of cardiovascular disease, but attention is growing on increased prevalence of left ventricular diastolic dysfunction in adults with DS. Interestingly, studies on AD are now investigating the relationship between heart and brain function. Aim of the present study is to evaluate the association between left ventricular diastolic dysfunction and cognitive impairment in adults with DS. Methods: We enrolled 27 adults with DS followed at the Day Hospital of Geriatrics at the Policlinico Gemelli, Universita` Cattolica del Sacro Cuore in Rome. Left ventricular diastolic function was evaluated through echocardiography with measurement of trans mitral flow and Tissue Doppler Imaging (TDI). Diastolic dysfunction was defined as an E/e >8. Cognitive impairment was evaluated with Raven Matrices and Wechsler Adult Intelligence Scale(WAIS) including verbal scale and performance scale. Results: In our sample (mean age 37.1±9.2 years; 78% females), 14 (52%) subjects showed diastolic dysfunction with a mean score in Raven matrices and WAIS scales (verbal and performance) of respectively 12.8±5.6, 9.1±4.1 and 8.9±4.2. After correction for age and gender, participants with diastolic dysfunction showed lower scores in the three cognitive performance scales as compared with those without diastolic dysfunction and: Raven matrices 10.8±1.1 vs. 15.8±1.4 (p = 0.011); WAIS verbal scale 7.5±0.7 vs. 10.1±0.7 (p = 0.017); WAIS performance scale 7.8±1.0 vs. 9.8±1.0 (p = 0.190). Conclusions: Left ventricular diastolic dysfunction is independently associated with reduced cognitive performance in adult subjects with DS.
S47
P-058 A better diagnostic differentiation between mild and major NCD when measuring everyday functioning E. Cornelis1 , E. Gorus2 , I. Bautmans3 , I. Beyer1 , P. De Vriendt3 1 Universitair Ziekenhuis Brussel, Jette, Belgium; 2 Vrije Universiteit Brussel, Jette, Belgium; 3 Belgium Objectives: According to DSM-V, differentiation between mild and major neurocognitive disorders (NCD) – or mild cognitive impairment (MCI) and dementia – is based on the preservation of everyday functioning. However, no established standards exist for measuring functional limitations for diagnostic purposes. Therefore, an evaluation for basic (b-) and instrumental (i-) activities of daily living (ADL) has been developed which assesses individualized functional impairment by distinguishing underlying causes of limitation. Expressed as percentages, it distinguishes a Global (DI), Cognitive (CDI) and Physical Disability Index (PDI) for both b- and i-ADL. Methods: The (construct and discriminative) validity and interrater reliability was evaluated in 154 community dwelling older persons (mean age 79.8; SD ±7.0), classified based upon a standard clinical evaluation as cognitively healthy (CH; n = 47) (controls), Mild Cognitive Impairment (MCI; n = 43) (mild NCD) and mild to moderate Alzheimer’s Disease (AD; n = 64) (major NCD). Separately, the new evaluation was administered. Results: The CDI showed accurate differentiation (p < 0.05) with a mean b-ADL-CDI of 0.0% for CH, 2.8% (SD ±7.1) for MCI and 8.9% (SD ±11.3) for AD, and a mean i-ADL-CDI of 1.8% for CH (SD ±5.7), 21.3% for MCI (SD ±19.7) and 50.9% for AD (SD ±22.8). The DI and PDI were only different between CH and patients (p < 0.001). ROC curves showed satisfactory results for DI and CDI of both b- and i-ADL, with an AUC ranging 0.687 to 0.992. Inter-rater reliability for all indices showed an ICC ranging 0.944 to 0.994. Conclusions: By distinguishing causes of limitations, evaluation of everyday functioning allows an accurate diagnostic classification in NCD. P-059 Creativity in Alzheimer’s Disease C. Cristini University of Brescia, Brescia, Italy Objectives: In Alzheimer’s Disease, despite limited brain activity, it may still to express creativity. Methods: We have examined some examples of creativity and dementia reported in scientific documents and several patients with Alzheimer’s Disease, living in nursing home, that have expressed their creativity by many paintings. Results: In old age, Immanuel Kant presents signs of cognitive decline. He appears to be aware of his disorder, expressing the pain of changes, the need to secure environmental and emotional reference points. His decline continues relentlessly, but he keeps his style, his cultural achievements, his feelings of gratitude, understanding and affection. Cary Smith Henderson, a professor of history, writes his journal, expressing his experience with Alzheimer’s disease. In advanced stages of the disease, he is able to grasp the meaning of situations and relationships; despite the difficulties and communication problems, he continues to have feelings and ideas that he would like to share with others. William Utermohlen, a painter, stricken by Alzheimer’s disease, continued to compose portraits following the inexorable progression of his decay; he has witnessed the decline of his cognitive functions, maintaining until the end a kind of artistic core. Utermohlen seems aware – at least in emotional terms – of what is happening to him. Many institutionalized elderly people express their creativity, their emotion, their thought drawing and painting. Sometimes their interesting works recall portraits of famous painters.
objectives, level of cognitive functionality, or guided neuropsychological exploring. We have designed a telerehabilitation innovative system that faces the clinical and technological challenges. Method: The initial and final evaluations have been carried out after an intervention period of 6 months. The target population was 115 persons at the beginning and 63 at the end, from which 25 (X=81, 38 years) lived in elderly population residences and 38 (X=77, 13 years) in the community. The cognitive profile was classified in 4 levels. The satisfaction was evaluated with validated questionnaires analyze telemedicine programs according to the Model for Assessment of Telemedicine Application and the levels of life quality according to the health questionnaire EUROQOL 5D. Results: The average cognitive level of the residential population was 1.72 and in the community, 2.50. The final level was 1.80 and 2.47, respectively. The satisfaction degree was considered to be excellent in 60% and good in 40%. The tool was considered to be recommendable in 80%. In the life quality of the residential population, 68% had a mobility issue, and 42% presented pain; meanwhile, in the communal population, 33% had a mobility issue and 42% presented pain. Conclusions: • Excellent acceptance of the tool • Usefulness of the tool to increase the life quality, without affecting the self-care • Decelerate the cognitive impairment in residential population. Minor improvement. P-057 Association between left ventricular diastolic function and cognitive performance in adults with Down syndrome A. Carfì1 , D.L. Vetrano2 , V. Brandi2 , F. Fiore1 , D. Mascia1 , S. Di Tella1 , R. Bernabei2 , G. Onder2 1 Department of Geriatrics – Catholic University of the Sacred Heart, Rome, Italy; 2 Italy Objectives: Down syndrome(DS) is characterized by high rates of early-onset age-related disorders and in particular persons with this condition are at high risk of experiencing Alzheimer disease(AD). Subjects with DS are also known for very low prevalence rates of cardiovascular disease, but attention is growing on increased prevalence of left ventricular diastolic dysfunction in adults with DS. Interestingly, studies on AD are now investigating the relationship between heart and brain function. Aim of the present study is to evaluate the association between left ventricular diastolic dysfunction and cognitive impairment in adults with DS. Methods: We enrolled 27 adults with DS followed at the Day Hospital of Geriatrics at the Policlinico Gemelli, Universita` Cattolica del Sacro Cuore in Rome. Left ventricular diastolic function was evaluated through echocardiography with measurement of trans mitral flow and Tissue Doppler Imaging (TDI). Diastolic dysfunction was defined as an E/e >8. Cognitive impairment was evaluated with Raven Matrices and Wechsler Adult Intelligence Scale(WAIS) including verbal scale and performance scale. Results: In our sample (mean age 37.1±9.2 years; 78% females), 14 (52%) subjects showed diastolic dysfunction with a mean score in Raven matrices and WAIS scales (verbal and performance) of respectively 12.8±5.6, 9.1±4.1 and 8.9±4.2. After correction for age and gender, participants with diastolic dysfunction showed lower scores in the three cognitive performance scales as compared with those without diastolic dysfunction and: Raven matrices 10.8±1.1 vs. 15.8±1.4 (p = 0.011); WAIS verbal scale 7.5±0.7 vs. 10.1±0.7 (p = 0.017); WAIS performance scale 7.8±1.0 vs. 9.8±1.0 (p = 0.190). Conclusions: Left ventricular diastolic dysfunction is independently associated with reduced cognitive performance in adult subjects with DS.
S47
P-058 A better diagnostic differentiation between mild and major NCD when measuring everyday functioning E. Cornelis1 , E. Gorus2 , I. Bautmans3 , I. Beyer1 , P. De Vriendt3 1 Universitair Ziekenhuis Brussel, Jette, Belgium; 2 Vrije Universiteit Brussel, Jette, Belgium; 3 Belgium Objectives: According to DSM-V, differentiation between mild and major neurocognitive disorders (NCD) – or mild cognitive impairment (MCI) and dementia – is based on the preservation of everyday functioning. However, no established standards exist for measuring functional limitations for diagnostic purposes. Therefore, an evaluation for basic (b-) and instrumental (i-) activities of daily living (ADL) has been developed which assesses individualized functional impairment by distinguishing underlying causes of limitation. Expressed as percentages, it distinguishes a Global (DI), Cognitive (CDI) and Physical Disability Index (PDI) for both b- and i-ADL. Methods: The (construct and discriminative) validity and interrater reliability was evaluated in 154 community dwelling older persons (mean age 79.8; SD ±7.0), classified based upon a standard clinical evaluation as cognitively healthy (CH; n = 47) (controls), Mild Cognitive Impairment (MCI; n = 43) (mild NCD) and mild to moderate Alzheimer’s Disease (AD; n = 64) (major NCD). Separately, the new evaluation was administered. Results: The CDI showed accurate differentiation (p < 0.05) with a mean b-ADL-CDI of 0.0% for CH, 2.8% (SD ±7.1) for MCI and 8.9% (SD ±11.3) for AD, and a mean i-ADL-CDI of 1.8% for CH (SD ±5.7), 21.3% for MCI (SD ±19.7) and 50.9% for AD (SD ±22.8). The DI and PDI were only different between CH and patients (p < 0.001). ROC curves showed satisfactory results for DI and CDI of both b- and i-ADL, with an AUC ranging 0.687 to 0.992. Inter-rater reliability for all indices showed an ICC ranging 0.944 to 0.994. Conclusions: By distinguishing causes of limitations, evaluation of everyday functioning allows an accurate diagnostic classification in NCD. P-059 Creativity in Alzheimer’s Disease C. Cristini University of Brescia, Brescia, Italy Objectives: In Alzheimer’s Disease, despite limited brain activity, it may still to express creativity. Methods: We have examined some examples of creativity and dementia reported in scientific documents and several patients with Alzheimer’s Disease, living in nursing home, that have expressed their creativity by many paintings. Results: In old age, Immanuel Kant presents signs of cognitive decline. He appears to be aware of his disorder, expressing the pain of changes, the need to secure environmental and emotional reference points. His decline continues relentlessly, but he keeps his style, his cultural achievements, his feelings of gratitude, understanding and affection. Cary Smith Henderson, a professor of history, writes his journal, expressing his experience with Alzheimer’s disease. In advanced stages of the disease, he is able to grasp the meaning of situations and relationships; despite the difficulties and communication problems, he continues to have feelings and ideas that he would like to share with others. William Utermohlen, a painter, stricken by Alzheimer’s disease, continued to compose portraits following the inexorable progression of his decay; he has witnessed the decline of his cognitive functions, maintaining until the end a kind of artistic core. Utermohlen seems aware – at least in emotional terms – of what is happening to him. Many institutionalized elderly people express their creativity, their emotion, their thought drawing and painting. Sometimes their interesting works recall portraits of famous painters.