- Email: [email protected]
P1-040 Diagnostic accuracy of MCI criteria for predementia AD
S 106
Poster Session PI: Diagnosis and Disease Progression - Clinical
patients (24%) rated their memory as either less good, poor, or miserable, while the majority of patients (N = 593, 76%) rated their memory as excellent or good. Patients with memory complaints were significantly older (mean age 76.1 vs. 74.7, p < 0.02), and had lower MMSE scores (mean MMSE 27.2 vs. 28.2, p < 0.001. Informant reports confirmed memory problems in 54% of patients with memory complaints, but also in 16% of patients with no self-reported memory problems. QoL as assessed with the VAS was 73.6 :E 18.2 and 60.8 -I-/18.6 (mean :1: SD) in patients without and with subjective memory complaints, respectively (p < 0.001). Conclusion: Although confirmed by informants in only half of cases, subjective memory complaints were frequent among unselected elderly patients consulting their GP, and memory complaints were significantly associated with reduced QoL. A significant proportion of elderly patients consulting their GP may be at risk for developing dementia or have already mild cognitive impairment.
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DIAGNOSTIC ACCURACY O F M C I C R I T E R I A F O R P R E D E M E N T I A AD
Pieter J. Visser*, Frans Verhey. University ofMaastrieht, Maastricht, Netherlands. Contact e-maih pj. [email protected] Background: Several definitions of mild cognitive impairment (MCI) have been proposed to identify subjects at high risk for predementia AD. It is not known which definition of MCI has the best diagnostic accuracy for predementia AD in a clinical setting. In addition, it is unknown whether the diagnostic accuracy of these criteria varies with age. Objectives: To compare the diagnostic accuracy of different MCI definitions for predementia AD in a cllnicai setting and to assess the effect of age on the diagnostic accuracy. Methods: Diagnostic accuracy was tested in 203 non-demented subjects from the Maastricht Memory Clinic with cognitive complaints who were older than 40 years and who had no medical condition that caused the cognitive impairment. A diagnosis of predementia AD at baseline (N = 44) was made if the subject developed AD-type dementia during a 5 year follow-up period. The diagnostic accuracy of the criteria for amnestic MCI, mild functional impairment (a score of 3 on the Global Deterioration Scale), AACD, and AAMI were investigated. Outcome measures were the sensitivity, positive predictive value (FPV), and diagnostic odds ratio (OR). Analyses were performed in the whole sample and in subgroups of subjects aged 40 to 50 years, 50 to 60 years, 60 to 70 years, and 70 to 85 years. Results: The sensitivity, PPV, and OR for predementia AD were respectively 52%, 43% and 6.6 for amnestic MCI, 68%, 33%, and 3.3 for mild functional impairment, 95%, 23%, and 2.4 for AACD, and 86%, 32%, and 5.9 for the AAMI criteria. The OR increased with higher age for all criteria except the AAMI criteria. The highest OR (13.8) was seen for the AAMI criteria in subjects who were 60 to 70 years old. The corresponding sensitivity was 95% and PPV was 51%. Conclusions: Diagnostic accuracy for predementia AD varies with the definion of MCI. Age influences the diagnostic accuracy. No MCI definition can accurately identify subjects with predementia AD. Other markers of AD should be taken into account in order to make an accurate diagnosis of predementia AD.
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LATINO PATIENTS W I T H A L Z H E I M E R ' S DISEASE HAVE AN E A R L I E R AGE O F S Y M P T O M ONSET COMPARED TO A N G L O S
Christopher M. Clark* 1, Charles DeCarli 2, Dan Mtmgas 2, Helena Chui 3, Roger Higdon 4, Jessica Nunez 1, Henrique Fernandez 1, Mirna Negron 1, Jennifer Manly 5, Isis Heruandez 3, Steven Ferris 6, Angelica Perez 6, Migdalia Torres 6, Douglas Ewbank 1, Guila Glosser 1, Gerald van Belle 4.
1University of Pennsylvania, Philadelphia, PA, USA; 2University of California, Davis, Davis, CA, USA; 3University of Southern California, Los Angeles, CA, USA; 4University of Washington, Seattle, WA, USA; 5Columbia University, New York, NZ, USA; 6New York University, New York, Ny, USA. Contact e-mail: [email protected] Background: Latinos are the largest minority group and the fasting growing population group in the United States, yet there are few studies comparing the clinical features of AD in this population group with those found in
Anglos. Objective(s): To compare the age of Alzheimer's disease (AD) symptom onset in Latinos and Anglos (non-Latino whites). Methods: Crosssectional assessment using standardized methods to collect and compare age of AD symptom onset, demographic and medical variables in 119 Latinos and 55 Anglos. Results: After adjusting for Center, gender and years of education, Latinos had a mean age of symptom onset 6.8 years earlier (95% CI 3.5 to 10.3 years earlier) than Anglos. Conclusions: An earlier age of symptom onset suggests that US mainland Latinos may experience an increased burden of Alzheimer's disease compared to Anglos. The basis for the younger age of symptom onset remains to be determined.
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A
CROSS-SECTIONAL STUDY O F T H E BEHAVIOURAL AND P S Y C H O L O G I C A L S Y M P T O M S OF D E M E N T I A (BPSD) IN 435 PATIENTS W I T H A L Z H E I M E R ' S DISEASE
Ajay Mirakhur*, David Craig, Dominic J. Hart, Stephen P. Mcllroy, Peter Passmore. Queen's University, Belfast, United Kingdom. Contact
e-maih [email protected] Background: The behavioural and psychological symptoms of Alzheimer's disease (AD) are associated with significant patient and caret distress and increased likelihood of institutionalisation. Objective(s): We have attempted to characterise these symptoms in depth, quantify their prevalence, and assess associated caregiver distress. Methods: Patients with probable AD were recruited from old age psychiatry and geriatric medicine memory clinics and assessed using the Mini Mental State Examination (MMSE), Functional Assessment Staging (FAST) and Neuropsychiatric Inventory (NPI-D). Resuits: Four hundred and thirty five patients were recruited, 66% were female. The mean age was 78 years (SD 7.47) and mean MMSE score was 13/30 (SD 9.24). Neuropsychiatric symptoms of all types, including affective, psychotic and behavioural problems, were highly prevalent with >90% having at least one behavioural change. The commonest symptom was apathy (75%). Depressive symptoms were present in 45% of all patients and delusions in 35%. Delusional symptoms were the earliest symptoms to appear and the least persistent. Delusions and hallucinations were significantly more common in moderate and severe dementia respectively. Symptoms of irritability were most prevalent in early disease. Caregivers rated their own emotional distress levels as moderate or severe for almost all symptoms. The total NPI score was significantly correlated with loss of functional ability and cognitive decline. Conclusions: Potentially treatable BPSD are common in AD and represent a major source of distress among caregivers. Neurospychiatric burden is seen to correlate with the level of functional and cognitive disability while some symptoms appear related to disease stage.
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CHANGES IN S E L F - R E P O R T E D P E R S O N A L I T Y COINCIDENT W I T H DECLINES IN COGNITION: RESULTS F R O M P A R A L L E L H O R M O N E T H E R A P Y TRIALS IN ELDERLY M E N AND W O M E N
Pauline M. Maki* 1.2, Susan M. Resnick 2 , Jason Brandt 3'4, Adrian R. Dobs 3, S. Chris Durso 3, Robert R. McCrae 2 . 1University of Illinois at
Chicago, Chicago, IL, USA; 2National Institute on Aging, Baltimore, MD, USA; 3Johns Hopkins University School of Medicine, Baltimore, MD, USA; 4Copper Ridge Institute, Sykesville, MD, USA. Contact e-mail: pmaki @psych.uic.edu Background: Although personality is stable in adulthood, prospective studies demonstrate specific personality changes in mild-to-moderate memoryimpaired adults. These changes, measured by the NEO-Personality Inventory Revised (NEO-PIR), include decreased Conscientiousness and increased Vulnerability (Siegel, 1994). Although personality inventories are less vulnerable to practice effects than cognitive tests, personality inventories are used infrequently in clinical trials of cognitive pharmacotherapies, including hormone interventions. Objective(s): To examine the effects of estrogerdprogesterone therapy and testosterone therapy in cognitively normal elderly women and men, respectively, on NEO-PIR scores. Methods: The study design was parallel randomized, double-blind, placebo-controlled,
Poster Session PI: Diagnosis and Disease Progression - Clinical
patients (24%) rated their memory as either less good, poor, or miserable, while the majority of patients (N = 593, 76%) rated their memory as excellent or good. Patients with memory complaints were significantly older (mean age 76.1 vs. 74.7, p < 0.02), and had lower MMSE scores (mean MMSE 27.2 vs. 28.2, p < 0.001. Informant reports confirmed memory problems in 54% of patients with memory complaints, but also in 16% of patients with no self-reported memory problems. QoL as assessed with the VAS was 73.6 :E 18.2 and 60.8 -I-/18.6 (mean :1: SD) in patients without and with subjective memory complaints, respectively (p < 0.001). Conclusion: Although confirmed by informants in only half of cases, subjective memory complaints were frequent among unselected elderly patients consulting their GP, and memory complaints were significantly associated with reduced QoL. A significant proportion of elderly patients consulting their GP may be at risk for developing dementia or have already mild cognitive impairment.
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DIAGNOSTIC ACCURACY O F M C I C R I T E R I A F O R P R E D E M E N T I A AD
Pieter J. Visser*, Frans Verhey. University ofMaastrieht, Maastricht, Netherlands. Contact e-maih pj. [email protected] Background: Several definitions of mild cognitive impairment (MCI) have been proposed to identify subjects at high risk for predementia AD. It is not known which definition of MCI has the best diagnostic accuracy for predementia AD in a clinical setting. In addition, it is unknown whether the diagnostic accuracy of these criteria varies with age. Objectives: To compare the diagnostic accuracy of different MCI definitions for predementia AD in a cllnicai setting and to assess the effect of age on the diagnostic accuracy. Methods: Diagnostic accuracy was tested in 203 non-demented subjects from the Maastricht Memory Clinic with cognitive complaints who were older than 40 years and who had no medical condition that caused the cognitive impairment. A diagnosis of predementia AD at baseline (N = 44) was made if the subject developed AD-type dementia during a 5 year follow-up period. The diagnostic accuracy of the criteria for amnestic MCI, mild functional impairment (a score of 3 on the Global Deterioration Scale), AACD, and AAMI were investigated. Outcome measures were the sensitivity, positive predictive value (FPV), and diagnostic odds ratio (OR). Analyses were performed in the whole sample and in subgroups of subjects aged 40 to 50 years, 50 to 60 years, 60 to 70 years, and 70 to 85 years. Results: The sensitivity, PPV, and OR for predementia AD were respectively 52%, 43% and 6.6 for amnestic MCI, 68%, 33%, and 3.3 for mild functional impairment, 95%, 23%, and 2.4 for AACD, and 86%, 32%, and 5.9 for the AAMI criteria. The OR increased with higher age for all criteria except the AAMI criteria. The highest OR (13.8) was seen for the AAMI criteria in subjects who were 60 to 70 years old. The corresponding sensitivity was 95% and PPV was 51%. Conclusions: Diagnostic accuracy for predementia AD varies with the definion of MCI. Age influences the diagnostic accuracy. No MCI definition can accurately identify subjects with predementia AD. Other markers of AD should be taken into account in order to make an accurate diagnosis of predementia AD.
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LATINO PATIENTS W I T H A L Z H E I M E R ' S DISEASE HAVE AN E A R L I E R AGE O F S Y M P T O M ONSET COMPARED TO A N G L O S
Christopher M. Clark* 1, Charles DeCarli 2, Dan Mtmgas 2, Helena Chui 3, Roger Higdon 4, Jessica Nunez 1, Henrique Fernandez 1, Mirna Negron 1, Jennifer Manly 5, Isis Heruandez 3, Steven Ferris 6, Angelica Perez 6, Migdalia Torres 6, Douglas Ewbank 1, Guila Glosser 1, Gerald van Belle 4.
1University of Pennsylvania, Philadelphia, PA, USA; 2University of California, Davis, Davis, CA, USA; 3University of Southern California, Los Angeles, CA, USA; 4University of Washington, Seattle, WA, USA; 5Columbia University, New York, NZ, USA; 6New York University, New York, Ny, USA. Contact e-mail: [email protected] Background: Latinos are the largest minority group and the fasting growing population group in the United States, yet there are few studies comparing the clinical features of AD in this population group with those found in
Anglos. Objective(s): To compare the age of Alzheimer's disease (AD) symptom onset in Latinos and Anglos (non-Latino whites). Methods: Crosssectional assessment using standardized methods to collect and compare age of AD symptom onset, demographic and medical variables in 119 Latinos and 55 Anglos. Results: After adjusting for Center, gender and years of education, Latinos had a mean age of symptom onset 6.8 years earlier (95% CI 3.5 to 10.3 years earlier) than Anglos. Conclusions: An earlier age of symptom onset suggests that US mainland Latinos may experience an increased burden of Alzheimer's disease compared to Anglos. The basis for the younger age of symptom onset remains to be determined.
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A
CROSS-SECTIONAL STUDY O F T H E BEHAVIOURAL AND P S Y C H O L O G I C A L S Y M P T O M S OF D E M E N T I A (BPSD) IN 435 PATIENTS W I T H A L Z H E I M E R ' S DISEASE
Ajay Mirakhur*, David Craig, Dominic J. Hart, Stephen P. Mcllroy, Peter Passmore. Queen's University, Belfast, United Kingdom. Contact
e-maih [email protected] Background: The behavioural and psychological symptoms of Alzheimer's disease (AD) are associated with significant patient and caret distress and increased likelihood of institutionalisation. Objective(s): We have attempted to characterise these symptoms in depth, quantify their prevalence, and assess associated caregiver distress. Methods: Patients with probable AD were recruited from old age psychiatry and geriatric medicine memory clinics and assessed using the Mini Mental State Examination (MMSE), Functional Assessment Staging (FAST) and Neuropsychiatric Inventory (NPI-D). Resuits: Four hundred and thirty five patients were recruited, 66% were female. The mean age was 78 years (SD 7.47) and mean MMSE score was 13/30 (SD 9.24). Neuropsychiatric symptoms of all types, including affective, psychotic and behavioural problems, were highly prevalent with >90% having at least one behavioural change. The commonest symptom was apathy (75%). Depressive symptoms were present in 45% of all patients and delusions in 35%. Delusional symptoms were the earliest symptoms to appear and the least persistent. Delusions and hallucinations were significantly more common in moderate and severe dementia respectively. Symptoms of irritability were most prevalent in early disease. Caregivers rated their own emotional distress levels as moderate or severe for almost all symptoms. The total NPI score was significantly correlated with loss of functional ability and cognitive decline. Conclusions: Potentially treatable BPSD are common in AD and represent a major source of distress among caregivers. Neurospychiatric burden is seen to correlate with the level of functional and cognitive disability while some symptoms appear related to disease stage.
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CHANGES IN S E L F - R E P O R T E D P E R S O N A L I T Y COINCIDENT W I T H DECLINES IN COGNITION: RESULTS F R O M P A R A L L E L H O R M O N E T H E R A P Y TRIALS IN ELDERLY M E N AND W O M E N
Pauline M. Maki* 1.2, Susan M. Resnick 2 , Jason Brandt 3'4, Adrian R. Dobs 3, S. Chris Durso 3, Robert R. McCrae 2 . 1University of Illinois at
Chicago, Chicago, IL, USA; 2National Institute on Aging, Baltimore, MD, USA; 3Johns Hopkins University School of Medicine, Baltimore, MD, USA; 4Copper Ridge Institute, Sykesville, MD, USA. Contact e-mail: pmaki @psych.uic.edu Background: Although personality is stable in adulthood, prospective studies demonstrate specific personality changes in mild-to-moderate memoryimpaired adults. These changes, measured by the NEO-Personality Inventory Revised (NEO-PIR), include decreased Conscientiousness and increased Vulnerability (Siegel, 1994). Although personality inventories are less vulnerable to practice effects than cognitive tests, personality inventories are used infrequently in clinical trials of cognitive pharmacotherapies, including hormone interventions. Objective(s): To examine the effects of estrogerdprogesterone therapy and testosterone therapy in cognitively normal elderly women and men, respectively, on NEO-PIR scores. Methods: The study design was parallel randomized, double-blind, placebo-controlled,