- Email: [email protected]
P.5.004 Detecting dementia and mild cognitive impairment from in a memory clinic
P5 Degenerative and neurological disorders criteria) at one year intervals. The evaluations were applied each 6 months. Results: The first results showed that demented subjects had considerable decline in episodic memory over 6 months, other people remained stable, but, 22% of these subjects were diganosed as dementia a year later. Conclusion: Longitudinal investigation of episodic memory might be an effective screening for preclinical dementia even at half year intervals.
References [1] Grober, E., Buschke H., Crystal H., et al. 1988: Screening for dementia by memory testing. Neurology, 38, 90(~903. [2] Folstein, M.F., Folstein, S.E., MacHugh, RR., 1975: Mini Mental State: a practical method for grading cognitive states of patients for the clinician. J. Psychiatr Res, 12: 18~198.
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Detecting dementia and mild cognitive impairment from in a memory clinic
J. Zarra 1 *, L. Schmidt 2. ]Hospital Italiano de La Plata, Psiquiatria, La Plata, Argentina; eHospital Centenario, Psiquiatria, Argentina Purpose: Neuropsychological tests of memory are used in the
early detection of dementia and mild cognitive impairment (MCI). This study examines the efficacy of a cognitive tests battery detecting mild cognitive impairment and dementia. M e t h o d s : In a total of 342 outpatients (dementia: 115, MCI: 227) were examined by using 16 neuropsychological tests (primary, semantic and episodic memory, psychomotor speed). Results: Patients with dementia perfomed sgnificant worse on all tests than the MCI group did. MCI group perfomed worse on tests of episodic and semantic memory only. Conclusion: Tests assessing episodic and semantic memory may be useful in the detection of MCI. Psychomotor speed tasks are also useful in the identification of manifest dementia.
References [1] Petersen, R.C, Smith, G.E., Waring, R.J. 1999.: Mild Cognitive Impairment: clinical characterization and outcome. Archives of Neurology 56: 303 308. [2] Almkvist, O, B/ickman, L. 1993: Detection and staging of early clinical dementia. Acta Neurologica Scandinavica, 88:10 15.
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Effectiveness of donepezil in the treatment of memory impairment after traumatic brain injury a systematic review
$559
far, to assess its efectiveness and safety by using appropriate meta-analytical techniques. This study presents the results of a systematic review and further meta-analysis on the effectiveness of donepezil (5 10ms/day) to improve memory problems after TBI. M e t h o d s : Several electronic databases were searched (until January 2005) for appropriate studies by using a sensible search strategy (PubMed, PsyCLIT, Web of Science, and the Cochrane Library). Additionally the Pharmaceutical Company Pfizer (Spain) was contacted to obtain a list of studies known to them, and Clinical Trials Registers were searched to locate on-going trials. It was a priori established that studies would be combined (if feasible) according to their design (comparative studies RCTs and observational studies with control for confounding -; one-group pretest-posttest studies) and rehabilitation period (acute: < 1 year after TBI; post-acute: > 1 year after TBI). We selected appropriate measures, reflecting improvement either in cognition or memory, as outcomes. Standardized effect size estimates between groups (db) or within group (dw) were calculated and pooled by using random effects models. S u m m a r y of Results: Over more than 400 possible hits, only 12 studies were relevant to our aims and, finally, 6 studies gave appropriate data to be included in a meta-analysis (3 one-group pretest-posttest studies; 1 comparative observational study and 2 RCTs). Nevertheless, outcome measures were so disparate that meta-analytical combination could be done in few occasions. Regarding acute treatment (3 comparative studies), donepezil could be effective for the improvement of general cognitive measures (n 2; db 0.59, 95% CI 0.11 to 1.06), whereas there was not clear indication for efficacy on verbal/auditory memory (n 1; db 0.04, 95% CI 0.73 to 0.65), and visual memory (n 1; db 0.22, 95% CI 0.25 to 0.68). On post-acute treatment (3 one-group pretest-posttest studies), donepezil could be effective for the improvement of general cognitive measures (n 1; dw 0.41, 95% CI 0.07 to 0.76), general memory (n 2; dw 0.61, 95% CI 0.10 to 1.13), and verbal/auditory memory (n 2; dw 0.34, 95% CI 0.03 to 0.66), but not for visual memory (n 2; dw 0.22, 95% CI 0.08 to 0.53). Conclusions: Even if results of efficacy seem encouraging, little attention was made in the original studies for safety outcomes. Case series have pointed to dose dependent cholinergic side effects and some studies have reported aggressiveness and irritability that must be pursued by new studies. Larger RCTs are needed to substantiate the safety and efficacy of donepezil for the treatment of memory impairment after TBI. Also outcome measures must be selected from a focussed neuropsychological battery instead of the wide array of measures so far reported. Study supported by Fundacion Mutua Madrilefia. Itziar Gflemes is a PhD candidate supported by Gobierno Vasco, Dpto de Sanidad (Exp #20041149).
t3. Javier 1 *, I. Gtiemes 2, N. Ibarra 3, J.I. Quemada 4. 1 University
of the Basque Countty. Medical School, NeurosciencePsychiatty, Leioa, Spain; 2The University of the Basque Countty, Neuroscience Psychiatry, Spain; 3Aita Menni Hospital, htstitute for Psychiatric Research, Spain; 4Aita Menni Hospital, Brain Injuty Setvice, Spain and aims: Recently donepezil, an acetylcholinesterase inhibitor with indication in cognitive disorders, has been advocated for its "off-label" use in the treatment of memory impairment sustained as a consequence of traumatic brain injury (TBI). Several narrative reviews have supported that use (Blount et al, 2002; Griffin et al, 2003) but none has tried, so Introduction
References [1] Blount, P.J., Nguyen, C.D., McDeavitt, J.T., 2002. Clinical use of cholinomimetic agents: A review. J Head Trauma Rehabil 17, 314321. [2] Griffin, S.L., van Reekum, R., Masanic, C., 2003. A review of cholinergic agents in the treatment of neurobehavioral deficits following traumatic brain injury. J Neuropsychiatry Clin Neurosci 15, 17 26.
References [1] Grober, E., Buschke H., Crystal H., et al. 1988: Screening for dementia by memory testing. Neurology, 38, 90(~903. [2] Folstein, M.F., Folstein, S.E., MacHugh, RR., 1975: Mini Mental State: a practical method for grading cognitive states of patients for the clinician. J. Psychiatr Res, 12: 18~198.
•
Detecting dementia and mild cognitive impairment from in a memory clinic
J. Zarra 1 *, L. Schmidt 2. ]Hospital Italiano de La Plata, Psiquiatria, La Plata, Argentina; eHospital Centenario, Psiquiatria, Argentina Purpose: Neuropsychological tests of memory are used in the
early detection of dementia and mild cognitive impairment (MCI). This study examines the efficacy of a cognitive tests battery detecting mild cognitive impairment and dementia. M e t h o d s : In a total of 342 outpatients (dementia: 115, MCI: 227) were examined by using 16 neuropsychological tests (primary, semantic and episodic memory, psychomotor speed). Results: Patients with dementia perfomed sgnificant worse on all tests than the MCI group did. MCI group perfomed worse on tests of episodic and semantic memory only. Conclusion: Tests assessing episodic and semantic memory may be useful in the detection of MCI. Psychomotor speed tasks are also useful in the identification of manifest dementia.
References [1] Petersen, R.C, Smith, G.E., Waring, R.J. 1999.: Mild Cognitive Impairment: clinical characterization and outcome. Archives of Neurology 56: 303 308. [2] Almkvist, O, B/ickman, L. 1993: Detection and staging of early clinical dementia. Acta Neurologica Scandinavica, 88:10 15.
•
Effectiveness of donepezil in the treatment of memory impairment after traumatic brain injury a systematic review
$559
far, to assess its efectiveness and safety by using appropriate meta-analytical techniques. This study presents the results of a systematic review and further meta-analysis on the effectiveness of donepezil (5 10ms/day) to improve memory problems after TBI. M e t h o d s : Several electronic databases were searched (until January 2005) for appropriate studies by using a sensible search strategy (PubMed, PsyCLIT, Web of Science, and the Cochrane Library). Additionally the Pharmaceutical Company Pfizer (Spain) was contacted to obtain a list of studies known to them, and Clinical Trials Registers were searched to locate on-going trials. It was a priori established that studies would be combined (if feasible) according to their design (comparative studies RCTs and observational studies with control for confounding -; one-group pretest-posttest studies) and rehabilitation period (acute: < 1 year after TBI; post-acute: > 1 year after TBI). We selected appropriate measures, reflecting improvement either in cognition or memory, as outcomes. Standardized effect size estimates between groups (db) or within group (dw) were calculated and pooled by using random effects models. S u m m a r y of Results: Over more than 400 possible hits, only 12 studies were relevant to our aims and, finally, 6 studies gave appropriate data to be included in a meta-analysis (3 one-group pretest-posttest studies; 1 comparative observational study and 2 RCTs). Nevertheless, outcome measures were so disparate that meta-analytical combination could be done in few occasions. Regarding acute treatment (3 comparative studies), donepezil could be effective for the improvement of general cognitive measures (n 2; db 0.59, 95% CI 0.11 to 1.06), whereas there was not clear indication for efficacy on verbal/auditory memory (n 1; db 0.04, 95% CI 0.73 to 0.65), and visual memory (n 1; db 0.22, 95% CI 0.25 to 0.68). On post-acute treatment (3 one-group pretest-posttest studies), donepezil could be effective for the improvement of general cognitive measures (n 1; dw 0.41, 95% CI 0.07 to 0.76), general memory (n 2; dw 0.61, 95% CI 0.10 to 1.13), and verbal/auditory memory (n 2; dw 0.34, 95% CI 0.03 to 0.66), but not for visual memory (n 2; dw 0.22, 95% CI 0.08 to 0.53). Conclusions: Even if results of efficacy seem encouraging, little attention was made in the original studies for safety outcomes. Case series have pointed to dose dependent cholinergic side effects and some studies have reported aggressiveness and irritability that must be pursued by new studies. Larger RCTs are needed to substantiate the safety and efficacy of donepezil for the treatment of memory impairment after TBI. Also outcome measures must be selected from a focussed neuropsychological battery instead of the wide array of measures so far reported. Study supported by Fundacion Mutua Madrilefia. Itziar Gflemes is a PhD candidate supported by Gobierno Vasco, Dpto de Sanidad (Exp #20041149).
t3. Javier 1 *, I. Gtiemes 2, N. Ibarra 3, J.I. Quemada 4. 1 University
of the Basque Countty. Medical School, NeurosciencePsychiatty, Leioa, Spain; 2The University of the Basque Countty, Neuroscience Psychiatry, Spain; 3Aita Menni Hospital, htstitute for Psychiatric Research, Spain; 4Aita Menni Hospital, Brain Injuty Setvice, Spain and aims: Recently donepezil, an acetylcholinesterase inhibitor with indication in cognitive disorders, has been advocated for its "off-label" use in the treatment of memory impairment sustained as a consequence of traumatic brain injury (TBI). Several narrative reviews have supported that use (Blount et al, 2002; Griffin et al, 2003) but none has tried, so Introduction
References [1] Blount, P.J., Nguyen, C.D., McDeavitt, J.T., 2002. Clinical use of cholinomimetic agents: A review. J Head Trauma Rehabil 17, 314321. [2] Griffin, S.L., van Reekum, R., Masanic, C., 2003. A review of cholinergic agents in the treatment of neurobehavioral deficits following traumatic brain injury. J Neuropsychiatry Clin Neurosci 15, 17 26.