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P202: Comparing objective measures of neurodegeneration in multiple sclerosis (MS)
Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
SMUP, reflecting the size of motor unit, increased with age of controls only in APB. CMAP amplitude correlated inversely with age of controls in APB and in ADM. The correlation between MUNE/CMAP amplitude of APB/ADM muscles and the age of females but not of men was found. Conclusions: Multipoint incremental MUNE method in Shefner’s modification is a non-invasive, easy to perform method with high reproducibility. The loss of motor neurons due to aging, appears to be more pronounced in healthy people over 45 yrs, especially in females.
P201 Late midlife sleep pattern and sleep structure and the association to age-related changes in cognition K.L.W. Waller 1 , B. Fagerlund 2 , K. Avlund 3 , M. Osler 3 , E. Lykke Mortensen 3 , M. Lauritzen 4 , P. Jennum 1 1 University of Copenhagen, Danish Center Sleep Medicine Glostrup Hospital, Copenhagen, Denmark; 2 University of Copenhagen, Psychiatric Centre Glostrup Hospital, Copenhagen, Denmark; 3 University of Copenhagen, Department of Public Health, Copenhagen, Denmark; 4 University of Copenhagen, Department of Clinical Neurophysiology, Copenhagen, Denmark Question: Advancing age is accompanied by changes in sleep pattern and increased prevalence of both sleep disturbances and cognitive impairment. Previous longitudinal studies exploring age dependent sleep and cognitive changes are scarce. Since disrupted sleep is linked to cognitive dysfunction we hypothesised that impaired sleep may be an early sign of cognitive deterioration. Methods: Participants were healthy males born in 1953 and recruited from the Metropolit Cohort. Based on previous cognitive assessments in young adulthood and late midlife, the participations were selected for the study as cognitively unimpaired (N=97) or cognitively impaired (N=92).Overnight polysomnographic recordings were collected from a total of 189 subjects. A neuropsychological battery was administered to confirm group differences in cognitive functioning at the time when sleep data were collected. The battery included Mini Mental State Examination (MMSE), Addenbrookes Cognitive Examination (ACE) Digit Substitution Symbol Test (SDMT), Trail Making A and B-test, 15 world pairs, and Cambridge Neuropsychological Test Automated Battery (CANTAB). The main outcome measure was incident sleep polysomnographic characteristics. Results: Cognitive impaired males showed lower sleep efficiency than cognitive unimpaired males 78.5±12.8 (78.54±12.82 vs.83.1±10.6, p=0.02) and increased nocturnal wakefulness (17.2±6.9 vs.12.8±9.3, p=0.02). Percent stage REM sleep was slightly increased in cognitively impaired males compared with the cognitively unimpaired (17.6±7.0 vs. 15.7±6.3, p=0.05). However, none of these polygraphic measures showed significant group differences after Bonferroni correction. Furthermore we found no strong correlation between sleep measures and cognitive test scores. Conclusion: Subtle cognitive changes show few, if any, associations with sleep per se. Future research is needed to study the heterogeneity of cognitive aging and potential predictors of cognitive decline.
P202 Comparing objective measures of neurodegeneration in multiple sclerosis (MS) V. Fernandez, M.J. Postigo, P. Urbaneja, A. Leon, A. Alonso, M. Guerrero, O. Fernández Hospital Regional Universitario Carlos Haya, Málaga, Spain Background: MS is a disease of the central nervous system (CNS) characterized by inflammation,demyelination and axonal loss. Neurodegeneration seems to be present from the beginning of the disease and is the main cause of progression ofirreversible neurological deficits. Easy and low cost measures of axonal loss are lacking. Evoked potentials allows us the functional study of CNS. Visual (VEP) and motor evoked potentials (MEP) have already demonstrated good correlation with disability progression in MS. Optical coherence tomography (OCT) measures the retinal nerve fiber layer (RNFL) and the macular ganglion cell layer thickness (GCL). Objectives: Investigate correlations between clinical measures of disability progression and OCTand evoked potential measures; and determine which objective measure correlates better. Material and methods: Prospective transversal study of 89 MS patients with PEV (latency p100; amplitude); MEP (magnetic stimulation; central conduction time-CCT, amplitude - average at least 3 supramaximal re-
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ponses, and amplitude ratio with compound motor action potential-CMAP) and OCT (RNFL (μm); GCL ((μm)). Results: The mean age of our patients was 39 years(18-58) with a mean evolution time of he disease of 6 years and mean EDSS of 2.6 (0–7). 31 (49.2%) patients had a relapsing-remitting form (EMRR).27% had an episode of unilateral optic neuritis and 8% had a history of bilateral neuritis. We found statistically significant differences for OCT and PEV measures (latency p100 (ms) and amplitude) between MS eyes with optic neuritis (NO) and controls (p=0.0001), and between eyes of MS patients without ON and controls. GCL correlates better with EDSS measures than RNFL. OCT, PEV and PEM measures were also correlated between them. PEM amplitude ratio with compound motor action potential-CMAP, was the measure strongly correlated with progression (EDSS) in the multivariant analysis (p=0.0001), and ROC analysis showed a value of AUC of 0.8 for detecting progression EDSS >4. Conclusion: We detected axonal loss in patients with MS, either in eyes with NO or without it, with structural-OCT and functional-PEV and PEM measures. PEM measures are well correlated with OCT and clinical measures of neurodegeneration. PEM amplitude ratio was the most informative measure on disability progression.
P203 Subjective sleep quality and daytime sleepiness in late midlife and the association to age-related changes in cognition K.L.W. Waller 1 , K. Avlund 2 , B. Fagerlund 3 , M. Osler 2 , E. Lykke Mortensen 2,4 , M. Lauritzen 4 , P. Jennum 1 1 Danish Center Sleep Medicien Glostrup Hospital University of Copenhagen, Department of Clinical Neurophysiology Danish Center Sleep Medicien Glostrup Hospital University of Copenhagen, Glostrup, Denmark; 2 Copenhagen University, Faculty of Health Science, Copenhagen, Denmark; 3 Copenhagen University, Psychiatric Centre Glostrup, Copenhagen, Denmark; 4 Copenhagen University, Department of Clinical Neurophysiology, Copenhagen, Denmark Question: Poor sleep quality and cognitive changes are complex health issues, associated with increased frailty, morbidity and mortality and potential risk factor for further cognitive decline. Previous research on the association between self-reported sleep measurements and cognitive performance are somewhat inconsistent and leaves uncertainty with regard to the causal relationship of disrupted sleep and cognitive decline. Diminished sleep measures may be considered as early predictors of cognitive deterioration. We aimed to examine whether subjective sleep pattern is associated with change in cognition in middle-aged males. Methods: 189 healthy males born in 1953 and recruited from the Metropolit Cohort. Based on previous cognitive assessments in young adulthood and late midlife, the participants were selected for the study as cognitively unimpaired (N=97) or cognitively impaired (N=92). The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) measured subjective sleep quality and daytime sleepiness. A comprehensive neuropsychological battery, including MMSE, ACE, Digit, Trail Making A and B-test, 15 world pairs, and Cambridge Neuropsychological Test Automated Battery (CANTAB) was administered to confirm group differences in cognitive functioning at the time when sleep data was collected. Results: Overall, the prevalence of poor sleep quality (global PSQI score ≥5), was found to be 41% and excessive daytime sleepiness occurred in 15% (ESS ≥10). Compared to cognitive unimpaired males, the cognitive impaired males showed significant lower subjective sleep quality (5.40±3.81vs.4.39±2.40, p=0.03) Mean ESS score was (cognitive impaired 5.84±3.42 vs. cognitive unimpaired 6.51±3.15, p>0.05).There were few and weak correlations between sleep parameters and cognitive test performance in the combined sample. Conclusion: Self- reported poor sleep quality was related to cognitive changes, whereas daytime sleepiness was not. Our results suggest that sleep quality may be an early marker of cognitive decline in midlife
P204 Electrophysiological assessment of dysautonomia in multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). A comparative study M. Nojszewska, A. Potulska-Chromik, Z. Jamrozik, P. Janik, Z.-P. Beata Z. Medical University of Warsaw, Neurology, Warsaw, Poland Question: The aim of the study was to perform the electrophysiological
SMUP, reflecting the size of motor unit, increased with age of controls only in APB. CMAP amplitude correlated inversely with age of controls in APB and in ADM. The correlation between MUNE/CMAP amplitude of APB/ADM muscles and the age of females but not of men was found. Conclusions: Multipoint incremental MUNE method in Shefner’s modification is a non-invasive, easy to perform method with high reproducibility. The loss of motor neurons due to aging, appears to be more pronounced in healthy people over 45 yrs, especially in females.
P201 Late midlife sleep pattern and sleep structure and the association to age-related changes in cognition K.L.W. Waller 1 , B. Fagerlund 2 , K. Avlund 3 , M. Osler 3 , E. Lykke Mortensen 3 , M. Lauritzen 4 , P. Jennum 1 1 University of Copenhagen, Danish Center Sleep Medicine Glostrup Hospital, Copenhagen, Denmark; 2 University of Copenhagen, Psychiatric Centre Glostrup Hospital, Copenhagen, Denmark; 3 University of Copenhagen, Department of Public Health, Copenhagen, Denmark; 4 University of Copenhagen, Department of Clinical Neurophysiology, Copenhagen, Denmark Question: Advancing age is accompanied by changes in sleep pattern and increased prevalence of both sleep disturbances and cognitive impairment. Previous longitudinal studies exploring age dependent sleep and cognitive changes are scarce. Since disrupted sleep is linked to cognitive dysfunction we hypothesised that impaired sleep may be an early sign of cognitive deterioration. Methods: Participants were healthy males born in 1953 and recruited from the Metropolit Cohort. Based on previous cognitive assessments in young adulthood and late midlife, the participations were selected for the study as cognitively unimpaired (N=97) or cognitively impaired (N=92).Overnight polysomnographic recordings were collected from a total of 189 subjects. A neuropsychological battery was administered to confirm group differences in cognitive functioning at the time when sleep data were collected. The battery included Mini Mental State Examination (MMSE), Addenbrookes Cognitive Examination (ACE) Digit Substitution Symbol Test (SDMT), Trail Making A and B-test, 15 world pairs, and Cambridge Neuropsychological Test Automated Battery (CANTAB). The main outcome measure was incident sleep polysomnographic characteristics. Results: Cognitive impaired males showed lower sleep efficiency than cognitive unimpaired males 78.5±12.8 (78.54±12.82 vs.83.1±10.6, p=0.02) and increased nocturnal wakefulness (17.2±6.9 vs.12.8±9.3, p=0.02). Percent stage REM sleep was slightly increased in cognitively impaired males compared with the cognitively unimpaired (17.6±7.0 vs. 15.7±6.3, p=0.05). However, none of these polygraphic measures showed significant group differences after Bonferroni correction. Furthermore we found no strong correlation between sleep measures and cognitive test scores. Conclusion: Subtle cognitive changes show few, if any, associations with sleep per se. Future research is needed to study the heterogeneity of cognitive aging and potential predictors of cognitive decline.
P202 Comparing objective measures of neurodegeneration in multiple sclerosis (MS) V. Fernandez, M.J. Postigo, P. Urbaneja, A. Leon, A. Alonso, M. Guerrero, O. Fernández Hospital Regional Universitario Carlos Haya, Málaga, Spain Background: MS is a disease of the central nervous system (CNS) characterized by inflammation,demyelination and axonal loss. Neurodegeneration seems to be present from the beginning of the disease and is the main cause of progression ofirreversible neurological deficits. Easy and low cost measures of axonal loss are lacking. Evoked potentials allows us the functional study of CNS. Visual (VEP) and motor evoked potentials (MEP) have already demonstrated good correlation with disability progression in MS. Optical coherence tomography (OCT) measures the retinal nerve fiber layer (RNFL) and the macular ganglion cell layer thickness (GCL). Objectives: Investigate correlations between clinical measures of disability progression and OCTand evoked potential measures; and determine which objective measure correlates better. Material and methods: Prospective transversal study of 89 MS patients with PEV (latency p100; amplitude); MEP (magnetic stimulation; central conduction time-CCT, amplitude - average at least 3 supramaximal re-
S101
ponses, and amplitude ratio with compound motor action potential-CMAP) and OCT (RNFL (μm); GCL ((μm)). Results: The mean age of our patients was 39 years(18-58) with a mean evolution time of he disease of 6 years and mean EDSS of 2.6 (0–7). 31 (49.2%) patients had a relapsing-remitting form (EMRR).27% had an episode of unilateral optic neuritis and 8% had a history of bilateral neuritis. We found statistically significant differences for OCT and PEV measures (latency p100 (ms) and amplitude) between MS eyes with optic neuritis (NO) and controls (p=0.0001), and between eyes of MS patients without ON and controls. GCL correlates better with EDSS measures than RNFL. OCT, PEV and PEM measures were also correlated between them. PEM amplitude ratio with compound motor action potential-CMAP, was the measure strongly correlated with progression (EDSS) in the multivariant analysis (p=0.0001), and ROC analysis showed a value of AUC of 0.8 for detecting progression EDSS >4. Conclusion: We detected axonal loss in patients with MS, either in eyes with NO or without it, with structural-OCT and functional-PEV and PEM measures. PEM measures are well correlated with OCT and clinical measures of neurodegeneration. PEM amplitude ratio was the most informative measure on disability progression.
P203 Subjective sleep quality and daytime sleepiness in late midlife and the association to age-related changes in cognition K.L.W. Waller 1 , K. Avlund 2 , B. Fagerlund 3 , M. Osler 2 , E. Lykke Mortensen 2,4 , M. Lauritzen 4 , P. Jennum 1 1 Danish Center Sleep Medicien Glostrup Hospital University of Copenhagen, Department of Clinical Neurophysiology Danish Center Sleep Medicien Glostrup Hospital University of Copenhagen, Glostrup, Denmark; 2 Copenhagen University, Faculty of Health Science, Copenhagen, Denmark; 3 Copenhagen University, Psychiatric Centre Glostrup, Copenhagen, Denmark; 4 Copenhagen University, Department of Clinical Neurophysiology, Copenhagen, Denmark Question: Poor sleep quality and cognitive changes are complex health issues, associated with increased frailty, morbidity and mortality and potential risk factor for further cognitive decline. Previous research on the association between self-reported sleep measurements and cognitive performance are somewhat inconsistent and leaves uncertainty with regard to the causal relationship of disrupted sleep and cognitive decline. Diminished sleep measures may be considered as early predictors of cognitive deterioration. We aimed to examine whether subjective sleep pattern is associated with change in cognition in middle-aged males. Methods: 189 healthy males born in 1953 and recruited from the Metropolit Cohort. Based on previous cognitive assessments in young adulthood and late midlife, the participants were selected for the study as cognitively unimpaired (N=97) or cognitively impaired (N=92). The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) measured subjective sleep quality and daytime sleepiness. A comprehensive neuropsychological battery, including MMSE, ACE, Digit, Trail Making A and B-test, 15 world pairs, and Cambridge Neuropsychological Test Automated Battery (CANTAB) was administered to confirm group differences in cognitive functioning at the time when sleep data was collected. Results: Overall, the prevalence of poor sleep quality (global PSQI score ≥5), was found to be 41% and excessive daytime sleepiness occurred in 15% (ESS ≥10). Compared to cognitive unimpaired males, the cognitive impaired males showed significant lower subjective sleep quality (5.40±3.81vs.4.39±2.40, p=0.03) Mean ESS score was (cognitive impaired 5.84±3.42 vs. cognitive unimpaired 6.51±3.15, p>0.05).There were few and weak correlations between sleep parameters and cognitive test performance in the combined sample. Conclusion: Self- reported poor sleep quality was related to cognitive changes, whereas daytime sleepiness was not. Our results suggest that sleep quality may be an early marker of cognitive decline in midlife
P204 Electrophysiological assessment of dysautonomia in multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). A comparative study M. Nojszewska, A. Potulska-Chromik, Z. Jamrozik, P. Janik, Z.-P. Beata Z. Medical University of Warsaw, Neurology, Warsaw, Poland Question: The aim of the study was to perform the electrophysiological