- Email: [email protected]
P2-108
Poster P2:: Monday Posters significantly more frequent in DLB compared to AD. Both DLB and AD patients exhibited impaired performance across the applied neuropsychological tasks. DLB group showed as more impaired on battery of visuospatial, constructional tasks and verbal fluency tests. Conclusions: DLB patients have different profile of clinical symptoms and neuropsychological deficits early in the course of dementia than AD group. These findings can be helpful in the differential diagnosis of dementia. P2-108
LANGUAGE ASSESSMENT IN DIFFERENT STAGES IN ALZHEIMERⴕS DISEASE: A COMPARATIVE STUDY
Teresa Cristina L. Romio, Paulo Henrique Bertolucci, Karin Zazo Ortiz, Federal University of San Paolo, San Paolo, Brazil. Contact e-mail: [email protected] Alzheimer’s Disease (AD) is usually associated with cognitive, language and behavioral impairments, which become more severe as the disease progresses. Language impairments are normally mild in the early phases, but they can become severe as disease progresses and modify the communication abilities. The aim of this study is to verify how language impairments become worse during the disease and which language abilities are more affected in each one of the AD⬘stages. We evaluated 24 patients meeting criteria for probable AD, 12 patients scored more than 23 at the Mini-Mental State Examination, and 12 scored between 13 and 22 points. All patients were evaluated by the Boston test (Goodglass & Kaplan, 1983;2001), and performed tasks involving oral and writing language abilities. Data acquired on this language evaluation were compared with the average of normal population data, with the same age and years of education. Patients that scored more than 23 showed statistical differences than compared with normal subjects just in visual confrontation naming and auditory comphrension tasks. In the group of patients that scored between 13 and 22, we found deterioration in all linguistic abilities. Besides the difficulties observed in the other group, they showed impairment in simple oral comphrension and reading comprehension of words, sentences and paragraphs, serial writing, words and sentences writing and writing confrontation naming. We concluded that language impairment seems to follow cognitive deterioration in AD. P2-109
TOPOGRAPHICAL DISORIENTATION IN ALZHEIMERⴕS DISEASE
Carla C. Guariglia, Ricardo Nitrini, FMUSP, Sa˜o Paulo, Brazil. Contact e-mail: [email protected] Background: Topographical disorientation is a common symptom in patients with Alzheimer⬘s disease (AD) that has not been as extensively studied as other common manifestations of this disease. Objective: To verify the occurrence of topographical disorientation in patients with Alzheimer’s disease (AD) and to identify which neuropsychological dysfunctions are causally related to the presence of this manifestation. Methods: Twenty seven patients meeting criteria for probable AD (12 female, 14 with mild dementia) and 30 subjects (21 female) without dementia were analyzed. The subjects and the caregivers were interviewed with a questionnaire on topographical orientation. The following tests were given: Mini mental state examination (MMSE), digit span, verbal fluency, cancellation task, Corsi’s block tapping test, point localization, line orientation judgment, three dimension and nonsense figure copy and mental rotation tests. Landmark recognition, personal orientation, and recalling routes were tested in a descriptive task and geographic knowledge was evaluated with a Brazilian map. Results: Patients and control subjects were not different regarding schooling years and gender. There were differences between patients and controls
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in the questionnaire on topographical orientation and in all tests except in visual spatial tasks. Patients with mild dementia had difference in the questionnaire, recalling routes, landmark recognition, personal orientation, geographical knowledge and line orientation judgment. Only the landmark recognition test was found to differentiate between patients with mild or moderate dementia. Conclusions: The topographic orientation questionnaire showed that even in mild dementia, AD patients have topographical disorientation. The landmark recognition, self-centered and world-centered orientation were precociously affected and may contribute to topographical disorientation. Spatial working memory and spatial visual functions are not compromised initially and probably did not contribute to topographical disorientation in the patients with mild dementia. However, patients with moderate dementia showed impairment in spatial working memory and spatial visual tests, which may have contributed to the topographic disorientation of these patients. P2-110
UTILITY OF THE CHINESE FRONTAL ASSESSMENT BATTERY IN ASIAN PATIENTS WITH EARLY DEMENTIA: A PILOT EXPERIENCE
Mei Sian Chong1, Wee Shiong Lim1, Jing Jih Chin1, Philomena Anthony2, Huey Charn Han2, Suresh Sahadevan3, 1 Department of Geriatric Medicine. Tan Tock Seng Hospital, Singapore, Singapore; 2Nursing Service. Tan Tock Seng Hospital, Singapore, Singapore; 3Department of General Medicine. Tan Tock Seng Hospital, Singapore, Singapore. Contact e-mail: [email protected] Background: Many of the commonly used cognitive screening instruments focus mainly on memory domains and inadequately assess executive function. The Frontal Assessment Battery is a useful and valid bedside screening test of executive dysfunction whose utility in early dementia has not been evaluated. Objective(s): To ascertain the utility of the Chinese Frontal Assessment Battery (CFAB) for evaluating executive dysfunction in early dementia in patients with Alzheimer’s disease (AD), vascular dementia (VD), or mixed dementia (MD) attending a tertiary referral clinic. Methods: We prospectively recruited 83 consecutive patients with a diagnosis of no dementia (n⫽29), mild cognitive impairment (MCI) (n⫽10), or early dementia (n⫽44). Dementia patients with global Clinical Dementia Rating ⱖ 2 and dementia aetiologies other than AD, VD and MD were excluded. The CFAB was administered by a single rater during the initial clinic visit. CFAB total and sub-item scores amongst the different diagnostic subgroups were analyzed using univariate and multivariate analyses. Correlations between CFAB and Chinese Mini Mental State Examination (CMMSE) scores were studied. Results: Mean CFAB total scores differed significantly between the non-demented (14.0⫾3.4), MCI (10.6⫾3.5) and early dementia (8.4⫾3.8) groups (P⬍0.05). All six CFAB sub-items discriminated between non-dementia and early dementia (P⬍0.05), while only the go-no-go sub-item distinguished MCI from non-dementia. After adjustment for sex and education, CFAB total scores were still significantly different between those with and without cognitive impairment (F-statistic 4.37, P⬍0.01). When analyzed by etiologic subtypes, both VD and MD groups had lower CFAB total scores compared with AD, despite having higher CMMSE scores. In support of the differential psychometric properties between CFAB and CMMSE is the low correlation between the two tests in early dementia (r⫽0.43, P⬍0.01), and in the AD (r⫽0.44, P⫽0.06) and VD (r⫽0.21, P⫽0.48) subgroups, although this was not seen in MD (r⫽0.69, P⫽0.01) Conclusions: Our study provides initial evidence of the utility of CFAB as an executive dysfunction screening instrument in early dementia that can complement the CMMSE with regard to detection of cognitive impairment and etiologic differentiation. Further validation studies are needed to ascertain its role in routine clinical use.
LANGUAGE ASSESSMENT IN DIFFERENT STAGES IN ALZHEIMERⴕS DISEASE: A COMPARATIVE STUDY
Teresa Cristina L. Romio, Paulo Henrique Bertolucci, Karin Zazo Ortiz, Federal University of San Paolo, San Paolo, Brazil. Contact e-mail: [email protected] Alzheimer’s Disease (AD) is usually associated with cognitive, language and behavioral impairments, which become more severe as the disease progresses. Language impairments are normally mild in the early phases, but they can become severe as disease progresses and modify the communication abilities. The aim of this study is to verify how language impairments become worse during the disease and which language abilities are more affected in each one of the AD⬘stages. We evaluated 24 patients meeting criteria for probable AD, 12 patients scored more than 23 at the Mini-Mental State Examination, and 12 scored between 13 and 22 points. All patients were evaluated by the Boston test (Goodglass & Kaplan, 1983;2001), and performed tasks involving oral and writing language abilities. Data acquired on this language evaluation were compared with the average of normal population data, with the same age and years of education. Patients that scored more than 23 showed statistical differences than compared with normal subjects just in visual confrontation naming and auditory comphrension tasks. In the group of patients that scored between 13 and 22, we found deterioration in all linguistic abilities. Besides the difficulties observed in the other group, they showed impairment in simple oral comphrension and reading comprehension of words, sentences and paragraphs, serial writing, words and sentences writing and writing confrontation naming. We concluded that language impairment seems to follow cognitive deterioration in AD. P2-109
TOPOGRAPHICAL DISORIENTATION IN ALZHEIMERⴕS DISEASE
Carla C. Guariglia, Ricardo Nitrini, FMUSP, Sa˜o Paulo, Brazil. Contact e-mail: [email protected] Background: Topographical disorientation is a common symptom in patients with Alzheimer⬘s disease (AD) that has not been as extensively studied as other common manifestations of this disease. Objective: To verify the occurrence of topographical disorientation in patients with Alzheimer’s disease (AD) and to identify which neuropsychological dysfunctions are causally related to the presence of this manifestation. Methods: Twenty seven patients meeting criteria for probable AD (12 female, 14 with mild dementia) and 30 subjects (21 female) without dementia were analyzed. The subjects and the caregivers were interviewed with a questionnaire on topographical orientation. The following tests were given: Mini mental state examination (MMSE), digit span, verbal fluency, cancellation task, Corsi’s block tapping test, point localization, line orientation judgment, three dimension and nonsense figure copy and mental rotation tests. Landmark recognition, personal orientation, and recalling routes were tested in a descriptive task and geographic knowledge was evaluated with a Brazilian map. Results: Patients and control subjects were not different regarding schooling years and gender. There were differences between patients and controls
S265
in the questionnaire on topographical orientation and in all tests except in visual spatial tasks. Patients with mild dementia had difference in the questionnaire, recalling routes, landmark recognition, personal orientation, geographical knowledge and line orientation judgment. Only the landmark recognition test was found to differentiate between patients with mild or moderate dementia. Conclusions: The topographic orientation questionnaire showed that even in mild dementia, AD patients have topographical disorientation. The landmark recognition, self-centered and world-centered orientation were precociously affected and may contribute to topographical disorientation. Spatial working memory and spatial visual functions are not compromised initially and probably did not contribute to topographical disorientation in the patients with mild dementia. However, patients with moderate dementia showed impairment in spatial working memory and spatial visual tests, which may have contributed to the topographic disorientation of these patients. P2-110
UTILITY OF THE CHINESE FRONTAL ASSESSMENT BATTERY IN ASIAN PATIENTS WITH EARLY DEMENTIA: A PILOT EXPERIENCE
Mei Sian Chong1, Wee Shiong Lim1, Jing Jih Chin1, Philomena Anthony2, Huey Charn Han2, Suresh Sahadevan3, 1 Department of Geriatric Medicine. Tan Tock Seng Hospital, Singapore, Singapore; 2Nursing Service. Tan Tock Seng Hospital, Singapore, Singapore; 3Department of General Medicine. Tan Tock Seng Hospital, Singapore, Singapore. Contact e-mail: [email protected] Background: Many of the commonly used cognitive screening instruments focus mainly on memory domains and inadequately assess executive function. The Frontal Assessment Battery is a useful and valid bedside screening test of executive dysfunction whose utility in early dementia has not been evaluated. Objective(s): To ascertain the utility of the Chinese Frontal Assessment Battery (CFAB) for evaluating executive dysfunction in early dementia in patients with Alzheimer’s disease (AD), vascular dementia (VD), or mixed dementia (MD) attending a tertiary referral clinic. Methods: We prospectively recruited 83 consecutive patients with a diagnosis of no dementia (n⫽29), mild cognitive impairment (MCI) (n⫽10), or early dementia (n⫽44). Dementia patients with global Clinical Dementia Rating ⱖ 2 and dementia aetiologies other than AD, VD and MD were excluded. The CFAB was administered by a single rater during the initial clinic visit. CFAB total and sub-item scores amongst the different diagnostic subgroups were analyzed using univariate and multivariate analyses. Correlations between CFAB and Chinese Mini Mental State Examination (CMMSE) scores were studied. Results: Mean CFAB total scores differed significantly between the non-demented (14.0⫾3.4), MCI (10.6⫾3.5) and early dementia (8.4⫾3.8) groups (P⬍0.05). All six CFAB sub-items discriminated between non-dementia and early dementia (P⬍0.05), while only the go-no-go sub-item distinguished MCI from non-dementia. After adjustment for sex and education, CFAB total scores were still significantly different between those with and without cognitive impairment (F-statistic 4.37, P⬍0.01). When analyzed by etiologic subtypes, both VD and MD groups had lower CFAB total scores compared with AD, despite having higher CMMSE scores. In support of the differential psychometric properties between CFAB and CMMSE is the low correlation between the two tests in early dementia (r⫽0.43, P⬍0.01), and in the AD (r⫽0.44, P⫽0.06) and VD (r⫽0.21, P⫽0.48) subgroups, although this was not seen in MD (r⫽0.69, P⫽0.01) Conclusions: Our study provides initial evidence of the utility of CFAB as an executive dysfunction screening instrument in early dementia that can complement the CMMSE with regard to detection of cognitive impairment and etiologic differentiation. Further validation studies are needed to ascertain its role in routine clinical use.