- Email: [email protected]
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Poster P2:: Monday Posters Background: Although several definitions of Mild Cognitive Impairment (MCI) have been proposed, the predictive validity of them has not been examined. Objective(s): We aimed to examine the validity from a longitudinal community-based study in Japan. Methods: After obtaining informed consent, a community sample of 1490 dementia-free individuals aged 65 and older was followed using neurolopsychological tests covering 5 domains of cognition (memory, attention, language, visuo-spatial, and reasoning) for 3 years. According to the method of Busse et al.(cut-off point of severity level:1.0, 1.5, 2.0 SD, presence or absence of subjective cognitive decline), we defined 18 types of modified MCI definition originating from three types of MCI (MCI-amnestic, MCI-multiple domains slightly impaired, MCI-single non-memory domain) on the basis of the examination results at the baseline. We standardized the results of the tests taking age, sex, and years of education into consideration. Three years later, 1023 of the original dementia-free participants underwent the second examination using the results of the same tests as the baseline, and we made a diagnosis of normal, MCI, and dementia for each participant. Results: The incidence of dementia during the observation period was 3.8% (1.3%/year). The convert rates from MCI to dementia showed a wide range difference depending on the subset of MCI employed. All six types of MCI-amnestic showed higher diagnostic specificity (more than 96%) but lower sensitivity (10% and less) in general. The use of modified criteria of MCI-multiple domains slightly impaired (original criteria except for the report of subjective cognitive decline and 1.0 SD cut-off level) showed relatively higher sensitivity (31%) but lower specificity (82%) and positive predictive power (7.4%). Conclusions: We should know the difference in sensitivity and specificity according to the subset of MCI. The convert rate from MCI to dementia appears to be different between community-based and clinic-based studies. P2-196
WHETHER DEPRESSIVE SYMPTOMS/SYNDROMES ARE PREDICTORS OF PROGRESSION IN MILD COGNITIVE IMPAIRMENT?
Tomasz Gabryelewicz, Anna Barczak, Elzbieta Luczywek, Boguslaw Wasiak, Maria Styczynska, Anna Pfeffer, Malgorzata Chodakowska, Krzysztof Czyzewski, Maria Barcikowska, Dept. of Neurodegenerative Dis., Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland. Contact e-mail: [email protected] Background: Mild cognitive impairment (MCI) is a heterogeneous group with a variety of clinical outcomes. Most of the subjects will convert to dementia, but some MCI may never progress to any significant extent or even improve. The field of MCI research is currently focusing on identifying the risk factors of disease progression for the purpose of early therapeutical intervention, which may in turn delay or even prevent the onset of dementia. Objective: The aim of this study was to detect if depressive symptoms/syndromes of the 10-item Montgomery-Asberg Depression Rating (MADRS) are the predictors of progression in persons with MCI. Method: The subjects of this study were 105 consecutive outpatients with MCI. All patients received annual clinical and psychometric examinations for up to mean three years, and were given routine laboratory tests, CT scans and SPECT. The diagnosis was made by a panel of specialists, who reviewed all existing information and used the criteria of Mayo Clinic Group. All subjects were assessed by experienced psychiatrist and given a MADRS. Depression was defined according to DSM-IV criteria. The subjects with severe major depressive disorder that may have contributed to the observed cognitive difficulties were excluded. Results: The subjects (n⫽105) were categorized into 2 groups based on their 3-year period of cognitive change: stable (n⫽42) and progression (n⫽63). Baseline mean MADRS score in progression group was significantly higher 11.3 (SD 5.6), max. 28 vs stable group 7.4 (SD 5.4), max. 19. The most frequently observed depressive symptoms, besides sadness (100%) and poor concentration (100%), were inner tension (91.5%) and pessimistic thoughts (91.5%), followed by lassitude (89.4), reduced sleep (87.2%), thoughts of death (65.9%), inability to feel (48.9%) and reduced appetite
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(23.4%). There were no significant correlations between MADRS score and age, sex, education, MMSE score and the presence of the APOE E4 allele. Conclusion: We found that higher baseline mean MADRS score was associated with progression group of MCI sample vs stable group. We conclude that depressive symptoms/syndromes may be predictors of more rapid progression in MCI. Efforts are warranted to identify and treat depression in MCI. P2-197
HYPOPERFUSION IN ANTERIOR CINGULATE CORTEX IN THE EARLIEST STAGE OF MILD COGNITIVE IMPAIRMENT: A COMMUNITYBASED STUDY
Kiyotaka Nemoto1,2, Fumio Yamashita3, Takashi Ohnishi2, Hiroshi Matsuda4, Takashi Asada3, 1Dept. of Psychiatry, University of Tsukuba Hospital, Ibaraki, Japan; 2Dept. of Radiology, National Center Hospital for Mental, Nervous, and Muscular Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan; 3Dept. of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan; 4 Dept. of Nuclear Medicine, Saitama Medical School Hospital, Saitama, Japan. Contact e-mail: [email protected] Background: Cerebral perfusion abnormalities in patients with early Alzheimer’s disease (AD) and mild cognitive impairment (MCI) are commonly seen in the posterior cingulate cortex and precuneus. However, it has not been clarified when the hypoperfusion occurs and what precedes the hypoperfusion. In the present study, we followed up cognitively normal elderly for three years, and investigated the change in the regional cerebral blood flow (rCBF) of the subjects who converted into MCI. Methods: A neuropsychological test battery was administered to 1711 communitydwelling elderly volunteers (mean age 74.4 years). The battery included tests of 5 domains of cognition; memory retrieval (cued recall), attention, language, visuospatial perception, and reasoning. We measured mean value and standard deviation (SD) for each domain and defined MCI as the score of memory retrieval is lower than mean-1.5SD and other scores are above mean-1SD, and normal as all scores of the domains above mean-1SD. Among these volunteers, 213 subjects (149 normal and 64 MCI at baseline) underwent Tc-99m-ECD SPECT. The same test battery was administered annually for three years; 27 of 149 originally normal subjects converted into MCI during the follow-up. In order to identify clusters of significantly reduced rCBF in the 27 MCI converters at the baseline relative to 122 normal subjects, voxel based group comparisons were made on the SPECT images at baseline, using the statistical parametric mapping approach. Furthermore, since 4 of these 27 MCI converters underwent follow-up SPECT 2 years later, we investigated the perfusion abnormalities of these 4 MCI converters at the follow-up. Results: MCI converters showed hypoperfusion in the caudal anterior cingulate cortex (ACC) at baseline. At the follow-up, MCI converters showed hypoperfusion in the left parahippocampal gyrus (p⬍0.05, with false discovery rate corrected for multiple comparison). Conclusion: MCI converters showed hypoperfusion in the caudal ACC even in the time when they showed no cognitive impairment. This indicates the possibility of detecting the earliest stage of the MCI with SPECT. As of hypoperfusion in parahippocampal gyrus in the follow-up SPECT, we will keep an eye on if the changes indicate the conversion from MCI to AD. P2-198
PATTERNS OF DECREASED GLUCOSE METABOLISM DIFFER AMONG YOUNGER AND OLDER MILD COGNITIVE IMPAIRMENT PATIENTS; AN FDG PET STUDY
Kejal Kantarci, Matthew Senjem, Brad Kemp, Val Lowe, Maria Shiung, Ronald Petersen, Bradley Boeve, David Knopman, Glenn Smith, Robert Ivnik, Eric Tangalos, Clifford Jack, Jr. Mayo Clinic, Rochester, MN, USA. Contact e-mail: [email protected] Background: Glucose metabolism on FDG PET is decreased in the posterior cingulate gyri as well as the parietal and temporal lobe association
WHETHER DEPRESSIVE SYMPTOMS/SYNDROMES ARE PREDICTORS OF PROGRESSION IN MILD COGNITIVE IMPAIRMENT?
Tomasz Gabryelewicz, Anna Barczak, Elzbieta Luczywek, Boguslaw Wasiak, Maria Styczynska, Anna Pfeffer, Malgorzata Chodakowska, Krzysztof Czyzewski, Maria Barcikowska, Dept. of Neurodegenerative Dis., Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland. Contact e-mail: [email protected] Background: Mild cognitive impairment (MCI) is a heterogeneous group with a variety of clinical outcomes. Most of the subjects will convert to dementia, but some MCI may never progress to any significant extent or even improve. The field of MCI research is currently focusing on identifying the risk factors of disease progression for the purpose of early therapeutical intervention, which may in turn delay or even prevent the onset of dementia. Objective: The aim of this study was to detect if depressive symptoms/syndromes of the 10-item Montgomery-Asberg Depression Rating (MADRS) are the predictors of progression in persons with MCI. Method: The subjects of this study were 105 consecutive outpatients with MCI. All patients received annual clinical and psychometric examinations for up to mean three years, and were given routine laboratory tests, CT scans and SPECT. The diagnosis was made by a panel of specialists, who reviewed all existing information and used the criteria of Mayo Clinic Group. All subjects were assessed by experienced psychiatrist and given a MADRS. Depression was defined according to DSM-IV criteria. The subjects with severe major depressive disorder that may have contributed to the observed cognitive difficulties were excluded. Results: The subjects (n⫽105) were categorized into 2 groups based on their 3-year period of cognitive change: stable (n⫽42) and progression (n⫽63). Baseline mean MADRS score in progression group was significantly higher 11.3 (SD 5.6), max. 28 vs stable group 7.4 (SD 5.4), max. 19. The most frequently observed depressive symptoms, besides sadness (100%) and poor concentration (100%), were inner tension (91.5%) and pessimistic thoughts (91.5%), followed by lassitude (89.4), reduced sleep (87.2%), thoughts of death (65.9%), inability to feel (48.9%) and reduced appetite
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(23.4%). There were no significant correlations between MADRS score and age, sex, education, MMSE score and the presence of the APOE E4 allele. Conclusion: We found that higher baseline mean MADRS score was associated with progression group of MCI sample vs stable group. We conclude that depressive symptoms/syndromes may be predictors of more rapid progression in MCI. Efforts are warranted to identify and treat depression in MCI. P2-197
HYPOPERFUSION IN ANTERIOR CINGULATE CORTEX IN THE EARLIEST STAGE OF MILD COGNITIVE IMPAIRMENT: A COMMUNITYBASED STUDY
Kiyotaka Nemoto1,2, Fumio Yamashita3, Takashi Ohnishi2, Hiroshi Matsuda4, Takashi Asada3, 1Dept. of Psychiatry, University of Tsukuba Hospital, Ibaraki, Japan; 2Dept. of Radiology, National Center Hospital for Mental, Nervous, and Muscular Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan; 3Dept. of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan; 4 Dept. of Nuclear Medicine, Saitama Medical School Hospital, Saitama, Japan. Contact e-mail: [email protected] Background: Cerebral perfusion abnormalities in patients with early Alzheimer’s disease (AD) and mild cognitive impairment (MCI) are commonly seen in the posterior cingulate cortex and precuneus. However, it has not been clarified when the hypoperfusion occurs and what precedes the hypoperfusion. In the present study, we followed up cognitively normal elderly for three years, and investigated the change in the regional cerebral blood flow (rCBF) of the subjects who converted into MCI. Methods: A neuropsychological test battery was administered to 1711 communitydwelling elderly volunteers (mean age 74.4 years). The battery included tests of 5 domains of cognition; memory retrieval (cued recall), attention, language, visuospatial perception, and reasoning. We measured mean value and standard deviation (SD) for each domain and defined MCI as the score of memory retrieval is lower than mean-1.5SD and other scores are above mean-1SD, and normal as all scores of the domains above mean-1SD. Among these volunteers, 213 subjects (149 normal and 64 MCI at baseline) underwent Tc-99m-ECD SPECT. The same test battery was administered annually for three years; 27 of 149 originally normal subjects converted into MCI during the follow-up. In order to identify clusters of significantly reduced rCBF in the 27 MCI converters at the baseline relative to 122 normal subjects, voxel based group comparisons were made on the SPECT images at baseline, using the statistical parametric mapping approach. Furthermore, since 4 of these 27 MCI converters underwent follow-up SPECT 2 years later, we investigated the perfusion abnormalities of these 4 MCI converters at the follow-up. Results: MCI converters showed hypoperfusion in the caudal anterior cingulate cortex (ACC) at baseline. At the follow-up, MCI converters showed hypoperfusion in the left parahippocampal gyrus (p⬍0.05, with false discovery rate corrected for multiple comparison). Conclusion: MCI converters showed hypoperfusion in the caudal ACC even in the time when they showed no cognitive impairment. This indicates the possibility of detecting the earliest stage of the MCI with SPECT. As of hypoperfusion in parahippocampal gyrus in the follow-up SPECT, we will keep an eye on if the changes indicate the conversion from MCI to AD. P2-198
PATTERNS OF DECREASED GLUCOSE METABOLISM DIFFER AMONG YOUNGER AND OLDER MILD COGNITIVE IMPAIRMENT PATIENTS; AN FDG PET STUDY
Kejal Kantarci, Matthew Senjem, Brad Kemp, Val Lowe, Maria Shiung, Ronald Petersen, Bradley Boeve, David Knopman, Glenn Smith, Robert Ivnik, Eric Tangalos, Clifford Jack, Jr. Mayo Clinic, Rochester, MN, USA. Contact e-mail: [email protected] Background: Glucose metabolism on FDG PET is decreased in the posterior cingulate gyri as well as the parietal and temporal lobe association