P3-005: The antisaccade task is sensitive to attention network integrity in normal elderly and dementia

Poster Presentations P3: for the first time with a dementia diagnosis in the nationwide hospital registers during the last six months of 2003. Through medical record review, we evaluated the completeness of the work-up on which the dementia diagnosis was based, using national and international evidencebased dementia guidelines as reference standards. Furthermore, based on the quality of the clinical information in the medical records and the clinical assessment of the patients who were alive at the time of the study and agreed to participate, we determined whether dementia diagnoses could be confirmed according to clinical diagnostic criteria for dementia. Results: The patients were from 45 hospitals located in 15 counties representing all hospital capture areas in Denmark. Medical records from 197 patients were reviewed and 51 patients were interviewed. According to the medical records, 89 (45.2%) were diagnosed with dementia without specification, 68 (34.5%) with Alzheimer’s disease (AD) and 29 (14.7%) with vascular dementia (VaD). A complete dementia work-up was done in only 39.6% of the patients and only 20.2% of those with incomplete work-up had documented referral to follow-up. Dementia syndrome was confirmed in 88.5%. AD was confirmed in 86.8%, but 30 AD cases were misclassified as dementia without specification and other subtypes. VaD was confirmed in only 20.7%. Conclusions: The adherence to clinical guidelines concerning dementia work-up is inadequate in the secondary health care sector. Although the clinical diagnosis of dementia as well as AD has a good validity, too many patients are not diagnosed with a correct subtype and AD is significantly underdiagnosed. Consequently, many patients with dementia today may not receive appropriate treatment and care. P3-003

COMORBIDITY, FUNCTIONAL AND NUTRITIONAL STATUS IN DEMENTED AND NON-DEMENTED PATIENTS STRATIFIED BY AGE

Giuseppe Bellelli1, Sara Morghen1, Marco Trabucchi2, 1Rehabilitation and Aged Care Unit Ancelle della Carita` hospital, Geriatric Research Group, Cremona and Brescia, Italy; 2Tor Vergata University and Geriatric Research Group, Rome and Brescia, Italy. Contact e-mail: [email protected] Background: to assess comorbid conditions, functional and nutritional status in patients with normal cognition or affected by dementia after stratification by age. Methods: A total of 1384 patients (⬎75 years), consecutively admitted to our Rehabilitation and Aged Care Unit (RACU) from January 2005 to December 2007, were recruited in this study. All of them underwent on admission a multidimensional assessment including socio-demographics (age, sex, living arrangement), comorbidity (Charlson Comorbidity Index, CCI), functional (Functional Independence Measure, FIM) and nutritional (Body Mass Index, BMI) status. Patients were divided by age ranges (75 to 84 years and ⬎85 years) and by the presence of dementia according to the DSM III-R criteria. Results: A total of 741 patients (484 with age ranging from 75 to 84 years) were not demented, while 643 (406 with age ranging from 75 to 84 years) were demented. Groups did not differ by sex. Both younger and older non-demented patients more frequently lived alone than their demented counterpart, but differences were significant only in groups of younger patients. Functional and nutritional status were significantly worse among demented patients, independently from age ranges (FIM ⫽ 67.6⫹/-27.8 in young demented vs. 85.9⫹/-23.3 in young non demented, p⫽.0001; FIM ⫽ 59.6⫹/-26.9 in old demented vs. 82.4⫹/-25.6 in old non demented, p⫽.0001; BMI ⫽ 24.4⫹/-4.8 in young demented vs. 25.1⫹/-5.0 in young non demented, p⫽.005; BMI ⫽ 22.8⫹/-4.1 in old demented vs. 23.6⫹/-4.7 in old non demented, p⫽.005). On the contrary, the level of comorbidity was the same only among the oldest patients (CCI ⫽ 1.8⫹/-1.3 in demented vs 1.7⫹/-1.3 in non demented, p⫽.08), while it was significantly higher in the demented in comparison to non-demented among the younger group (CCI ⫽ 2.1⫹/-1.6 in demented vs. 1.6⫹/-1.3 in non demented, p⫽.0001). Conclusions: Demented and non demented patients had poorer functional and nutritional status independently from age groups; on the contrary,

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comorbidity was significantly higher in young demented patients, while it was not different among demented and non demented patients of the old group. Data suggest that old demented patients probably receive a less specific attention towards somatic diseases in comparison to their younger counterpart. P3-004

PAST HORMONE REPLACEMENT USE ATTENUATES THE COGNITIVE DEFICITS IN ALZHEIMER’S DISEASE PATIENTS

Kara A. Bottiggi1, Leslie Baxter1, Donald Connor2, James Comer3, Anne Herring4, Richard J. Caselli5, 1Barrow Neurological Institute, Phoenix, AZ, USA; 2Sun Health Research Institute, Sun City, AZ, USA; 3 Southern Arizona VA Heallthcare System, Tucson, AZ, USA; 4 University of Arizona, Tucson, AZ, USA; 5Mayo Clinic, Scottsdale, AZ, USA. Contact e-mail: [email protected] Background: Studies examining whether hormone therapy (HT) use alters the risk of Alzheimer’s disease (AD) have been inconclusive. To date, the impact of HT on AD has been limited to studies of whether HT modifies the disease course. In another study, we found that in cognitively normal women, past HT use benefited cognitive functioning, even if the use was not continuous. The current study examined whether HT use impacted cognitive patterns in AD women. Methods: Data obtained from the Arizona Alzheimer’s Disease Consortium was used to compare post-menopausal AD women categorized as Current Users (CHT; n⫽20), Past Users (PHT;n⫽18), or Never Users (NHT;n⫽11). The average age of all participants was 73.6 (SD⫽9.7) and mean education level was 14.1 (SD⫽2.5) years; there were no differences between groups. Furthermore, there were no group differences in ADL levels or CDR scores, suggesting a similar disease stage. Multivariate analysis of variance (MANOVA) was conducted examining group differences on measures of global cognitive status (Mattis Dementia Rating Scale; DRS), memory (Rey Auditory Verbal Learning Test and the Brief Visuospatial Memory Test), and executive functioning (verbal fluency; COWAT, Trail Making Test, and Clock Drawing). Results: Results revealed that the PHT group performed better than the NHT group on the DRS (p ⫽.02), COWAT (p ⬍.01), and Clock Drawing (p ⫽.03). No significant group differences were observed on memory measures. Score differences were meaningful, with mean differences of 31.5 points (possible 144) on the DRS, 17.6 words on the COWAT, and 3.4 (possible 10 points) on the Clock Drawing test. To further evaluate HT use in AD, we categorized these women based on DRS scores (e.g., “higher” and “lower” functioning) and found significant differences using a Chi-square analysis (p⬍.05). The “higher” group (n⫽29; mean DRS⫽68.4) was 45% PHT, 45% CHT, and 10% NHT while the “lower” group (n⫽20; mean DRS⫽119.8) was 25% PHT, 35% CHT, and 40% NHT. The length of illness was similar among women in the higher group, suggesting that there is less of a decline in cognitive functioning in the HT users. Conclusions: These findings suggest that HT may attenuate cognitive deficits in AD. P3-005

THE ANTISACCADE TASK IS SENSITIVE TO ATTENTION NETWORK INTEGRITY IN NORMAL ELDERLY AND DEMENTIA

Adam L. Boxer1, Alisa Matlin2, Daniel Handwerker3, Siobhan Garbutt4, Joanna Hellmuth2, Ana Schenk2, Simona Brambati2, Marilu Gorno-Tempini2, Stephen G. Lisberger2, Bruce L. Miller2, Roland G. Henry2, 1UCSF Memory and Aging Center, San Francisco, CA, USA; 2UCSF, San Francisco, CA, USA; 3NIH, Bethesda, MD, USA; 4 Northwestern, Evanston, IL, USA. Contact e-mail: [email protected] Background: The antisaccade (AS) task is a well-established measure of overt attention control. It requires an individual to inhibit a reflexive shift of gaze towards a target and instead look in the opposite direction. Our previous studies have demonstrated that AS performance is sensitive to the presence of Alzheimer’s disease (AD) or frontotemporal dementia, and is

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correlated with neuropsychological measures of cognitive function as well as gray matter volume in the right frontal eye field (FEF) region. We investigated the fMRI correlates of AS performance in normal elderly (NE) individuals. Methods: AS performance measured using an infrared eye tracker was evaluated in 20 NE (CDR ⫽ 0), 7 individuals with mild cognitive impairment (MCI; CDR ⫽ 0.5) and 10 individuals with mild AD (CDR ⫽ 1.0). Subsequently, 11 NE (mean age 65) and 9 younger (mean age 25) controls performed blocks of AS trials alternating with a prosaccade control condition during fMRI on a GE 3T MR scanner. AS-related BOLD signal was correlated with AS performance measured outside the scanner using SPM5. Results: There was an effect of diagnostic group on AS performance (ANOVA, F⫽27.8, p ⬍0.001), with each group’s performance significantly different from the others’ (p ⬍ 0.05, Tukey post hoc). NE performed 85.2⫾3.8%, MCI performed 48.3⫾8.8% and mild AD performed 23.4⫾5.8% of AS trials correctly. Notably, there were 4 NE who displayed impaired AS performance (⬍ 81% correct). AS performance predicted MMSE score, after controlling for diagnosis, age and gender (linear regression, r2⫽0.70, p ⬍0.001). After controlling for age, the percentage of correct AS responses was correlated with fMRI BOLD signal (p ⬍ 0.01, FWE corrected) in the right FEF region, with more BOLD signal observed outside the cortical oculomotor regions in NE with impaired AS performance. Conclusions: The AS task is sensitive to ADrelated cognitive dysfunction. Our preliminary fMRI data suggest that AS impairments in NE reflect altered function of the same brain regions involved in attention control that are sensitive to AS-related atrophy in neurodegenerative dementia. Further studies are warranted to determine whether AS impairment in NE indicates an increased risk of future cognitive impairment. P3-006

COGNITIVE PERFORMANCE TEST: VALIDITY OF THE NEW MEDBOX SUBTASK

Theressa Burns, J. Riley McCarten, Michael Kuskowski, VA Medical Center GRECC, Minneapolis, MN, USA. Contact e-mail: [email protected] Background: The Cognitive Performance Test (CPT), widely used by occupational therapists, comprises seven subtasks (Medbox, Shop, Wash, Toast, Phone, Dress, Travel) for which the task cues and working memory requirements are systematically varied to assess ordinal levels of functional cognition. Derived from Allen Theory, performance is rated on a six level continuum divided further into modes of performance. All CPT tasks are considered universal in that they share similar cognitive processes and complexity levels for rating performance. Previous research established reliability and validity with MMSE and caregiver-rated IADL/ADL. CPT decline was found with disease progression and initial scores predicted risk for institutionalization over the 4-year follow up period (see Burns & Levy, 2006 for review). CPT total scores predict capacity to function in various contexts and help to guide intervention plans. Medication non-adherence is associated with a diagnosis of dementia. Over and under adherence, inability to manage co-morbidities, and having 4 or more medications are associated risks. Medbox was added to the original CPT and is not meant to directly measure the patient’s medication regime. It involves following standard label directions of varying complexity on 4 bottles of dummy medications (beads) to set up 2 pillboxes accordingly. Methods: Fortythree consecutive patients referred for diagnosis to the GRECC Memory Loss Clinic were administered the new Medbox subtask as part of the CPT battery. Mean age was 67.8 (8.5), and MMSE, 17.5 (5.0). Results: Spearman correlation for Medbox with CPT total score was significant (r ⫽ .678; p ⬍ .01). Except for Travel, intercorrelations between subtasks were significant ranging from 0.30 to 0.51. Conclusions: Medbox is highly correlated to the CPT total score as a working memory measure of functional cognition. CPT is used to explain and predict IADL function including ability to manage medication regimes. In CPT 5, the person can manage and learn regimes including compensations. In CPT 4, set-up and close monitoring for adherence are required. In CPT 3, 2 and 1, medications need to be given and access restricted. The value of adding Medbox

to the CPT is that it offers face-valid information for patient and caregiver education. P3-007

INSTABILITY OF A DIAGNOSIS OF MILD COGNITIVE IMPAIRMENT BASED ON A BRIEF SCREENING ASSESSMENT OF ENGLISH- AND SPANISH-SPEAKING INDIVIDUALS IN A GENERAL CARE CLINIC

Su P. Cartmell, Sharon X. Xie, Patricia Martinez, Jessica Nunez, Peter Janis, Young Baek, Jason H. T. Karlawish, Steven E. Arnold, Christopher M. Clark, University of Pennsylvania, Philadelphia, PA, USA. Contact e-mail: [email protected] Background: Individuals evaluated in a dementia specialty clinic who met standard criteria for mild cognitive impairment (MCI) are at increased risk for progression to dementia. However there is considerable uncertainty about the implications of that diagnosis when it is based on assessments that use brief functional and cognitive screening tools in a general medical clinic. The objectives of this study were; (1) to determine the stability over 8 to 15 months of a clinical designation of MCI based on performance on a brief assessment of individuals attending a general care clinic and (2) to assess the validity of the diagnostic categories of cognitively normal, mild cognitive impairment, and dementia when based on an individual’s performance on a brief screening assessment. Methods: One hundred ninetysix (127 English speaking and 69 Spanish speaking) elderly individuals from three general care practices received initial and one year screening assessments. To assess the validity of the screening category, 122 subjects completed a comprehensive evaluation within 90 days of their initial screen. Results: At baseline 56 (29%) met screening criteria for MCI. At follow-up screening (12 ⫹/-3 months) 8 (14%) progressed to meet screening criteria for dementia and 18 (32%) remained in the MCI category. However, 30 (54%) improved their performance enough to meet criteria for the cognitively normal screening category. Expert evaluation validated the screening diagnostic of dementia 91% of the time, but only 63% of the time when the screening assessment indicated no cognitive impairment and only 41% of the time when the screening diagnosis was MCI. Conclusions: Brief cognitive screening measures provide an efficient, reliable approach to the identification of patients attending a general care practice who meet clinical criteria for dementia. However, they perform less well as valid markers of both normal cognition and mild cognitive impairment. In addition, a cognitive screening diagnosis of MCI does not provide a reliable indication of their cognitive performance 9 to 15 months later. P3-008

ASSOCIATED CEREBRAL LESIONS IN ALZHEIMER’S DISEASE GENERATE CLINICAL DIAGNOSIS DIFFICULTIES: AN AUTOPSY STUDY

Vincent Deramecourt1, Ste´phanie Bombois1, Marie-Anne Mackowiak1, Andre´ Delacourte2, Luc Buee2, Claude-Alain Maurage3,2, Florence Lebert1, Florence Pasquier1, 1Memory Clinic, EA 2691, Lille University Hospital, Lille, France; 2INSERM U 837, Lille, France; 3 Department of neuropathology, Lille University Hospital, Lille, France. Contact e-mail: [email protected] Background: Associated cerebral lesions are highly prevalent in autopsy cohorts of Alzheimer’s disease (AD) patients, especially cerebrovascular lesions (Va) and Lewy body disease (LBD). These lesions can modify the clinical presentation of the patients, and therefore make the etiological diagnosis of dementia more difficult. Methods: To investigate the prevalence and the effect on clinical diagnosis accuracy of associated cerebral lesions with AD, we analysed the clinical, neuropathological and biochemical data of 60 patients (among the 106 last autopsies performed in our center) who underwent longitudinal premortem clinical follow-up. Results: Thirty three patients (55%) received a clinical diagnosis of probable AD, 17 (28.3%) patients were clinically diagnosed with AD and significant cerebrovascular lesions (AD⫹Va), and 10 patients (16.7%) had probable Lewy body variant of AD