P37-9 Default mode network in patients with Alzheimer's disease and Parkinson's disease: an fMRI study

S324 P37-5 Global functional coupling of resting EEG related to white-matter lesions along the cholinergic tracts in amnesic mild cognitive impairment subjects F. Vecchio1 , C. Babiloni2,3 , G. Frisoni4 , M. Pievani4 , C. De Carli5 , R. Ferri6 , F. Vernieri7 , R. Lizio8 , P.M. Rossini3,7 1 A.Fa.R., Dip. Neurosci. Osp. FBF; Isola Tiberina, Rome, Italy, 2 Department of Biomedical Sciences, University of Foggia, Foggia, Italy, 3 Casa di Cura San Raffaele Cassino, Italy, 4 IRCCS “S. Giovanni di Dio-F.B.F.”, Brescia, Italy, 5 Department of Neurology and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California at Davis, Sacramento, USA, 6 IRCCS Oasi, Troina, Italy, 7 Clin. Neurol. University “Campus Biomedico” Rome, Italy, 8 IRCCS San Raffaele Pisana, Rome, Italy Objective: We tested the hypothesis that global functional coupling of resting cortical electroencephalographic (EEG) rhythms is abnormal in amnesic mild cognitive impairment (MCI) patients with remarkable lesions along the cholinergic white-matter tracts. Methods: We used the eyes-closed resting EEG data (10 20 montage) of the same groups of 28 healthy elderly (Nold) and 57 MCI subjects of a previous reference study. The estimation of the cholinergic lesion was performed with a validated semi-automatic algorithm based on fluidattenuated inversion recovery sequences on MRI. The MCI patients were divided into groups of high (MCI+; N = 29) and low (MCI ; N = 28) cholinergic damage. EEG rhythms of interest were delta (2 4 Hz), theta (4 8 Hz), alpha 1 (8 10.5 Hz), alpha 2 (10.5 13 Hz), beta 1 (13 20 Hz), beta 2 (20 30 Hz), gamma (30 40 Hz). The global functional coupling of the EEG rhythms was indexed computing the spectral coherence between each electrode and the other 18 electrodes (“electrode” coherence) and then averaging the “electrode” coherence of all 19 electrodes (total coherence). Results: Total coherence of alpha 1 rhythms was highest in the Nold, intermediate in the MCI , and lowest in the MCI+ groups. Furthermore, the alpha1 total coherence was negatively correlated to (moderate to high) cholinergic lesion across the MCI subjects. Conclusions: In conclusion, damage to the cholinergic system is associated with alterations of the functional global coupling of resting alpha rhythms. P37-6 The EEG patterns of drowsiness that are related to abnormal cognitive decline in elderly M. Saito1 , M. Takahashi1 , H. Tagaya2 , H. Miyaoka1 1 Department of Psychiatry, Kitasato University School of Medicine, Kanagawa, Japan, 2 Kitasato University School of Allied Health Sciences, Kanagawa, Japan Objective: To investigate the EEG patterns that appear during the transition from wakefulness to sleep, and could be related to abnormal cognitive decline in elderly persons. Methods: Routine diurnal EEG’s of serial 268 subjects who complained of forgetfulness were investigated. Cognitive screening, MRI, and SPECT were also performed to make each subject’s diagnosis. EEG patterns of drowsiness were identified according to the classification of Santamaria and Chiappa. Results: Patients with Alzheimer’s disease (n = 75, p = 0.004), or mild cognitive impairment (n = 46, p = 0.026), who have no or minimal vascular lesion, showed significantly increased occurrence rate of sleep-related high-amplitude delta activity or sleep spindles before the wakefulnessrelated (mostly alpha) activities diminished, than normal elderly subjects (n = 20). Conclusions: Early occurrence of sleep pattern waveforms during drowsiness could possibly be useful in discriminating patients with either mild cognitive impairment or Alzheimer’s disease from normal elderly persons.

Posters P37-7 Low-resolution electromagnetic tomography (LORETA) analysis in advanced semantic dementia patients K. Nishida1 , M. Yoshimura1 , Y. Kitaura1 , T. Isotani2 , S. Morita1 , T. Kinoshita1 1 Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan, 2 Department of Psychiatry, Koizumi Hospital, Hiroshima, Japan Objective: Semantic dementia is subtype of frontotemporal lobar degeneration (FTLD). The clinical feature of semantic dementia is loss of semantic memory, and its pathological change is unilateral atrophy of anterior temporal lobes. The aim of this study was to investigate the features of quantitative EEG in moderate or severe stage of semantic dementia, because EEG is a non-invasive, cost-effective and sensitive to changes in the functional state of the human brain. Methods: We performed a quantitative EEG study in 4 right handed patients with semantic dementia (3 females and 1 males, 2 patients were in moderate stage and other 2 patients were in severe stage; mean age and SD: 68.5±5.7 years) and 22 normal control subjects (10 females and 12 males; mean age and SD: 66.1±6.0 years). EEGs were recorded from 19 scalp sites (Fp1/2, F3/4, C3/4, P3/4, O1/2, F7/8, T3/4, T5/6, Fz, Cz, Pz) according to international 10/20 electrode system during eyesclosed, resting condition. Current density computed by sLORETA was for the seven frequency bands (delta: 1.5 6 Hz, theta: 6.5 8 Hz, alpha1: 8.5 10 Hz, alpha2: 10.5 12 Hz, beta1: 12.5 18 Hz, beta2: 18.5 21 Hz, beta3: 21.5 30 Hz). Results: sLORETA with subject-wise normalization specified that semantic dementia patients showed stronger activity than normal controls in left temporal lobe in delta frequency band (p = 0.006). The activity was significantly higher for normal control in parietal and occipital lobe in alpha frequency band. Conclusion: Current density in delta and alpha band reflected pathological change in left temporal lobe and decline of brain function. P37-8 Comparison between mild Alzheimer’s disease and frontotemporal dementia using quantitative EEG K. Nishida1 , M. Yoshimura1 , Y. Kitaura1 , T. Isotani2 , T. Kinoshita1 Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan, 2 Department of Psychiatry, Koizumi Hospital, Hiroshima, Japan

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Objective: It is difficult for the clinicians to correctly distinguish Alzheimer’s disease (AD) and frontotemporal dementia (FTD) in its early stages based on clinical symptoms alone; and even with the help of imaging tools. So we investigate quantitative EEG in AD and FTD patients, because EEG is sensitive to changes in the state of the human brain. Methods: To clarify the differences in EEG between AD and FTD, we performed the Global field power (GFP) and the sLORETA analysis in mild stage of FTD (n = 19) and AD (n = 19) patients. EEGs were recorded from 19 scalp electrodes; scalp sites according to international 10/20 electrode system during eyes-closed, resting condition. Current density computed by sLORETA was for the seven frequency bands (delta: 1.5 6 Hz, theta: 6.5 8 Hz, alpha1: 8.5 10 Hz, alpha2: 10.5 12 Hz, beta1: 12.5 18 Hz, beta2: 18.5 21 Hz, beta3: 21.5 30 Hz). Results: In the GFP analysis, significant group effects were observed in the beta1 and beta2 band. FTD exhibited greater activity in the parietal lobes and the dorsal frontal lobes. The strongest difference was in Brodmann area 6 in the beta1 band, and Brodmann area 32 in the beta2 band. Conclusion:FTD patients exhibit a higher beta current density than AD patients do, which may cause the difference between the initial symptoms of FTD and AD, and that FTD might be associated with major depressive disorders. P37-9 Default mode network in patients with Alzheimer’s disease and Parkinson’s disease: an fMRI study I. Rektorova1 , L. Krajcovicova1 , M. Mikl1 , R. Marecek1 , I. Rektor1 First Department of Neurology, Masaryk University and St. Anne’s Hospital, Brno, Czech Republic 1

Methods and Aims: We studied the default mode system (DMS) during both the resting state and the performance of a visual memory task (VMT) in three groups: 18 patients with Alzheimer’s disease (AD), 18 patients with Parkinson’s disease on dopaminergic medication (PD), and 18 healthy

29th International Congress of Clinical Neurophysiology controls (HC). The strength of functional connectivity (FC) within the DMS, and the FC between the DMS and other cerebral regions was also evaluated and compared between the appropriate patient groups and the HC. The effect of levodopa equivalent doses (LEDs) on the DMS integrity and the FC was studied specifically in PD. Addenbrooke’s Cognitive Examination (ACE-R) used for cognitive testing, imaging performed using 1.5 T scanner; data analyses done using SPM5 and GIFT toolboxes under Matlab 7.6. Results and Conclusions: We demonstrated (i) a significant effect of age on the subjects DMS integrity (p = 0.046 FWE), (ii) a specific impairment of the DMS in AD patients as compared to HC (p = 0.026 FWE, cluster level inference), (iii) no significant differences in DMS integrity between cognitively normal PD patients on medication and HC. We observed (i) a significant impact of LED on the strength of the FC within the DMN (p = 0.022 FWE, small volume correction using the PCC region as a mask), (ii) and a significant impact of LED on the strength of the anti-correlation between P/PCC and the SN (p = 0.002 FWE, small volume correction using SN as a mask). Supported by the Research Project MSM 0021622404. P37-10 Detection of the dementia of the Alzheimer type using easy Z-score imaging system and voxel-based specific regional analysis system S. Higashiyama1 , J. Kawabe1 , H. Hashimoto2 , K. Kataoka2 , E. Kawamura1 , A. Yoshida1 , K. Kotani1 , T. Kai2 , K. Inoue2 , N. Kiriike2 , S. Shiomi1 1 Department of Nuclear Medicine, Osaka City University, Graduate School of Medicine, Osaka, Japan, 2 Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan The easy Z-score imaging system (eZIS) and the voxel-based specific regional analysis system for Alzheimer disease (VSRAD) are statistical image analyses that are performed for the diagnosis of dementia of the Alzheimer type (DAT). We performed eZIS and VSRAD analyses in patients suspected of having DAT. We also examined the DAT detection capabilities of both the systems. In this study, the sample population comprised 27 patients (22 women and 5 men; mean age, 72.7 years) who underwent cognitive function test, brain perfusion single-photon emission computed tomography (SPECT), and brain magnetic resonance imaging (MRI). The SPECT and MRI images were statistically analyzed using eZIS and VSRAD, respectively. Out of the 19 patients who were clinically diagnosed with DAT, 16 were diagnosed by eZIS and 14 were diagnosed by VSRAD. Among 3 patients diagnosed with DAT by VSRAD, eZIS showed that none of them had blood flow reduction in the cingulate gyrus and precuneus, but they had blood flow reduction in the parahippocampal gyrus. Therefore, we report that it is necessary to examine the parahippocampal gyrus as well as the cingulate gyrus and precuneus for the diagnosis of DAT using eZIS. P37-11 Effects of a comprehensive rehabilitation on functional outcome associated with increased right insular glucose metabolism in vascular dementia N. Tanaka1 , K. Meguro1 , H. Ishikawa1 , H. Ishii1,2 , M. Sugawara3 , S. Yamaguchi1,4 1 Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan, 2 Kawasaki Kokoro Hospital, Kawasaki, Japan, 3 Kagobou-no-sato, Osaki, Japan, 4 Osaki-Tajiri SKIP Center, Osaki, Japan Objective: To investigate the effect of a comprehensive rehabilitation approach on functional outcome and cerebral glucose metabolism in patients with vascular dementia (VaD). Methods: Eight VaD patients participated in this study. Inclusion criteria included a diagnosis of probable VaD according to the NINDS-AIREN criteria, an MMSE score of 10 or higher, and a need for physical assistance in sit-to-stand transfer activities. Exclusion criteria included an absence of insular lesions. Six of the eight patients were enrolled in a comprehensive rehabilitation program that consisted of an individualized task-oriented exercise regimen of transfer training and a psychosocial intervention program. The remaining two patients participated in the exercise program but were encouraged to have simple social contacts in place of the psychosocial intervention. They served as a control group matched for the site of the major lesion and the severity of hemiparesis or hemiplegia. These rehabilitation programs were undertaken over a period of 2 months. Outcomes were assessed by masked raters based

S325 on the scores of the MMSE, the Functional Independence Measure (FIM) and regional cerebral metabolism using 18 F-fluorodeoxyglucose PET in all patients before the program began and at the end of the program. Results: The score on the transfer mobility subscale of the FIM increased at the end of the program in all patients who received the comprehensive program. These increases indicated less dependence. Regional glucose metabolism was increased in the right insula cortex at the end of the comprehensive program based on statistical parametric mapping using a paired t-test. In control patients, there was no significant change in either the FIM score or the regional cerebral metabolism. Conclusions: A successful comprehensive rehabilitation approach might be associated with an increase in the glucose metabolism of the right insula cortex in VaD patients. P37-12 Improvement of working memory after bilateral prefrontal transcranial DC stimulation in healthy elderly M.-H. Ko1 , M.-H. Seo1 , K.-J. Ihm1 , J.-H. Seo1 , Y.-H. Kim2 Department of Physical Medicine & Rehabilitation, Medical Device Clinical Trial Center, Chonbuk National University Hospital, Jeonju, Korea, 2 Department of Physical Medicine & Rehabilitation, Sungkyunkwan University School of Medicine & Samsung Medical Center, Seoul, Korea

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Introduction: Noninvasive transcranial direct current stimulation (tDCS) can modulate the cortical excitability and has been applied for improvement of brain functions. We investigated the effects of bilateral prefrontal tDCS in healthy elderly by means of verbal and visual working memory tasks. Methods: Fifteen healthy elderly (9 males, 6 females, and mean age 70.7) were enrolled in this study. A sham controlled, double-bline and cross-over study study were conducted. Subjects underwent three experimental sessions, (1) sham, (2) anodal DC over left prefrontal (F3), and (3) dual anodal DC over bilateral prefrontal (F3&F4 in 10 20 EEG system) cortices. DC was delivered for 20 minute at 2 mA with 25 cm2 saline-soaked sponge electrodes. Cathode electrode was applied on left arm. Before and after tDCS, subjects were performed 2-back verbal working memory and visual memory tasks. The improvement rate of the accuracy and the reaction time after three sesstions were analyzed using ANOVA and post-hoc t-test. Results: In 2-back verbal working memory task, the improvement rate of accuracy was significantly higher after bilateral prefrontal tDCS (8.2%) than sham ( 0.2) (P = 0.04), the improvement rate of reaction time was also significantly higher after bilteral prefrontal tDCS (7.9%) than sham ( 2.1%) (P = 0.01). In visual working memory task, the improvement rate of reaction time was significantly higher after single left prefrontal tDCS (13.6%) than sham ( 0.1%) (P = 0.01) and bilateral prefrontal tDCS (13.7%) than sham (P = 0.02). Conclusions: The results showed beneficial effects of noninvasive transcranial anodal DC stimulation on cognitive function in healthy elderly. Especially, the bilateral prefrontal anodal tDCS can be more effective method to improve working memory. We suggest that tDCinduced changes in neural excitability could be provide an adjuvant treatment tool for facilitating cognitive function in elderly population. P37-13 Validation of the Korean version of the Addenbrooke’s cognitive examination to diagnose Alzheimer’s dementia in Korean population J.-H. Heo1 , T.-H. Park1 , J.-Y. Ahn1 , M.-K. Kim1 1 Department of Neurology, Seoul Medical Center, Seoul, Korea Background: The Addenbrooke’s Cognitive Examination (ACE) is a valid dementia scressing test simple and effective instruments. We aimed to assess the diagnostic accuracy of the Korean version ACE (K-ACE) in a Korean Population. Methods: A total of 80 subjects (33 Alzheimer dementia, 23 Mild cognitive impairment, 24 control) who visitied the neurology outpatient clinic of Seoul Medical Center were included. ACE was translated and modified to K-ACE. Sensitivity, specificity, area under curve, reliability, and VerbalLanguage/Orientation-Memory (VLOM) ratio were evaluated. The receiver operating characteristic (ROC) curve was used to determine optimal cutoff score in screening dementia. Results: The ROC curves showed the superiority of the K-ACE over Korean Mini-mental Status Examination (K-MMSE) in diagnosis of Alzheimer dementia and Mild cognitive impairment. The optimal cut-off of the K-ACE