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P.5.a.002 Relationships between writing errors and cognitive impairment in elderly psychiatric patients
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P.5.a Dementia and neurological disorders – Dementia disorders (clinical)
[2] Sheehan D.V., Lecrubier Y., Sheehan H.K. et al., 1998, The Mini International Neurospychiatric Interview (M.I.N.I) The Development and Validation of a Strudtured Diagnostic Psychiatric Interview for DSM-IV and ICD-10, Journal of Clinical Psychiatry, 59, suppl. 20, 22−33. [3] Spielberger C, 1983, Manual for the state-trait anxiety inventory, Revised edition, Palo Alto, Calif, Consulting Psychologists Press.
P.5 Dementia and neurological disorders P.5.a Dementia disorders (clinical) P.5.a.001 Galantamine in the treatment of Alzheimer’s disease K.L. Latalova, V. Pidrman ° . Palacky University Olomouc, Department of Psychiatry, Olomouc, Czech Republic Authors present results of a one-year open follow-up of galantamine efficacy and tolerability in the outpatient treatment of Alzheimer’s disease (AD). Diagnosis: psychiatric examination, NINCDS-ADRDA criteria. Efficacy was evaluated based on the assessment of cognitive functioning (MMSE scale) and activities of daily living (ADL) – DAD scale. Patients with AD – MMSE 16−20 without other serious disease. Efficacy was assessed prior to inclusion in the study and every 3 months (the end of months 3, 6, 9, 12) thereafter. Adverse effects were assessed every 2 weeks during the first and second month of treatment, than at the end of months 3, 6, 9, 12. Tolerability: assessment of blood pressure, heart rate and body weight changes; spontaneous patient/caregiver complaints of adverse effects during the treatment were also recorded. Therapy: patients received titrated doses of galantamine – first month 8 mg, from the beginning of second month 16 mg. No other psychoactive agents were used. 27 patients (20 women, 7 men) were included in the follow-up. 13 patients were at the age of 74 years or less (69.6, SD 3.55), 14 patients were older than 74 years (79.1, SD 2.82). Summary: 20 patients (74%) completed the 12 months followup. Four patients were excluded by the end of 9th month; 3 more patients by the end of the 12th month. Progression of the disease was the reasons for patient exclusion. Incidence of adverse effects was low – most common adverse effects presenting during the first few days of treatment and after the dose increase included: nausea, dizziness and headache. Adverse effects affected one fourth to one third of patients, but did not require any pharmacological assistance or reduction of galantamine dosage. No patient had to be excluded as a result of adverse effects. Changes of blood pressure and heart rate were not statistically significant during the follow-up. MMSE scores showed statistically significant (p = 0.01) increase in the whole sample from 17.3 (SD 1.52) to 19.0 (SD 2.39) at the end. DAD scores also showed statistically significant (p = 0.002) increase from 59.5 (SD 14.59) to 77.0 (SD 13.96). Classification of responders/non-responders: patients that showed improvement of MMSE during the one-year follow-up or patients without any change or patients with deterioration by not more than 1 point were classified as responders. 13 patients were as responders and 14 patients as non-responders. The difference in MMSE scores between responders and non-responders was statistically significant in the 6th month (p = 0.008). Non-responders showed MMSE values lower or similar to the initial examination. This is also true for DAD scores (p = 0.017). Evaluation of body weight showed significantly higher number of patients with unaltered or increased body weight in the group of responders.
Conclusion: The whole sample showed significant improvement, examination in the 6th month has a predictive value, responders did not loose their weight. Blood pressure and heart rate did not change.
P.5.a.002 Relationships between writing errors and cognitive impairment in elderly psychiatric patients S.C. Tamasan1 ° , D. Reisz2 . 1 Clinic Emergency Hospital, Psychiatry, Timisoara, Romania; 2 University of Medicine and Pharmacy “V Babes”, Neurology, Timisoara, Romania Objectives: to investigate if a brief easy to administer and to interpret writing test can assist in screening seniors with common psychopathology such as cognitive impairment, depressed or anxious mood. We expect to distinguish between cognitive impairment and depression and anxiety in this population, and to find writing markers for dementia. Methods: Forty four consecutive consenting patients seeking treatment at the outpatient psychiatric clinic of a general hospital (Clinic Emergency Hospital Timisoara, Romania) were assessed. The patients were 50 years of age or older, MMSE scores > 20, and had no other psychopathology but dementia (of Alzheimer or mixed type), mild cognitive disorder, and depression. There were excluded patients with major organic pathology, delirium, and poor medical condition. Cognitive performance and depressive and/or anxious symptoms were assessed using MMSE (Mini Mental State Examination) and Hamilton Rating Scale scores (21 items Hamilton Rating Scale for Depression respective 14 items Hamilton Anxiety Scale). Demographic data and subjective social support data were collected. Writing errors were assessed as following: writing of three self-elaborated sentences, copying a twenty-three words sentence, and timed. A writing error was considered: miss-punctuation, typos, repetitive or missing words, and incomprehensive syntax. Results: MMSE score grouped patients in nondemented (MMSE score 25−30) 28 (63.6%), and demented (MMSE score < 25) 16 (34.4%) patients. Thirteen patients (29.5%) manifested no anxiety, 21 (47.7%) mild anxiety (HAM-A score 18−24), and 10 (22.7%) moderate anxiety (based on HAM-A > 24). Eight (18.1%) patients manifested mild depression (scoring between 7 and 17 on 21 items HAM-D), 18 (40.9%) moderate depression (HAM-D score 18−24), and 17 (38.6%) severe depression (HAM-D > 24). The average duration of copying task was 131 seconds (range between 40 and 320 seconds). There was an inverse correlation between the time spent copying the text and MMSE score (−0.614 Pearson correlation) as well as an inverse correlation between MMSE and letters substitutions (−0.486). MMSE score inversely correlated with letters omissions (-0.542), inserted letters (−0.533), letter and word repetitions (−0.306) and showed a direct correlation with the lack of complexity of spontaneous elaborated sentences and incomprehensive syntax (0.372). There was no correlation with age (0.256), education (−0.110), subjective perceived social support (0.280). Depression score correlate mildly and positively only with age (0.324) and has no significant relation with social support and marital status. Conclusions: a quick, simple and accessible writing test can identify cases posing challenge in clinical daily practice: mild cognitive impairment, onset of dementia and depression. Using writing test we discover a set of dementia specific writing features, unrelated neither with anxious-depressive states nor with other
P.5.a Dementia and neurological disorders – Dementia disorders (clinical) demographic characteristics or social support. The copying task might assessed not simply the writing but also working memory, attention, visual scanning and also the complex understanding of a general meaning of the phrase.
P.5.a.003 Effect of functional diet BT-11 (Polygala tenuifolia Willdenow) on subjective memory impairment and mild cognitive impairment in older people S.H. Kim1 , H.Y. Jung2 ° , J.S. Yi3 , J.Y. Lee2 , K.Y. Shin4 , G.H. Lee4 , Y.H. Suh4 , Y.S. Kim5 . 1 Guro Hospital, College of Medicine Korea University, Psychiatry, Seoul, Republic of Korea; 2 Boramae Hospital, College of Medicine Seoul National University, Psychiatry, Seoul, Republic of Korea; 3 Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Psychiatry, Seoul, Republic of Korea; 4 College of Medicine Seoul National University, Pharmacology, Seoul, Republic of Korea; 5 Seoul National University College of Medicine, Seoul National University Hospital, Psychiatry, Seoul, Republic of Korea Background: Subjective memory impairment (SMI) and mild cognitive impairment (MCI) are often thought as transitional states from normal aging to dementia. Compared to healthy people, the risk of dementia increases fourfold and ten- to twentyfold in people with SMI and MCI, respectively. Therefore, it is needed to develop a new treatment strategy for improving the cognitive functions or preventing cognitive deterioration in this high risk population. Polygala tenuifolia has been known to inhibit the activity of acetylcholinesterase and the cytotoxicity of amyloid beta protein. It was developed as a functional diet for improving memory in Korea. We investigated whether the extract of dried root of Polygala tenuifolia Willdenow (BT-11) enhanced cognitive functions in elderly Korean people with SMI and MCI. Methods: Fifty three subjects (over sixty years old) with SMI (n = 35) and MCI (n = 18) were enrolled from the local mental community health center and Seoul National University Boramae Hospital. MCI was diagnosed by the Peterson’s criteria of mild cognitive impairment. All of the subjects completed an 8-week, randomized, double-blind, placebo-controlled trial. They were randomly assigned to one of the two groups taking 300 mg/d of BT-11 or placebo. We evaluated the cognitive functions of the subjects using the Korean versions of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet (CERAD-K) and the Mini-Mental Status Examination (MMSE-K) at baseline and after 8-week medication. The safety of BT-11 was examined by complete blood counting, blood chemistry, urinalysis and electrocardiogram. Between group comparison was made by t-test and Mann-Whitney test. Paired t-test was used for the comparison of clinical variables before and after medication. All statistical analyses were two-tailed, and a p-value of 0.05 was considered to be statistically significant. Summary of Results: The mean age of subject was 68.4 years. Eight were male and forty five were female. There were no significant differences in demographic variables and baseline cognitive functions between the two groups. In the BT-11 group (n = 28), the improvement of total scores of CERAD-K and MMSE-K was significantly higher than those in the placebo group (n = 25) (p = 0.003). In subscales of CERAD-K, the scores of word list learning, constructional praxis, constructional recall, and Boston naming test were improved significantly in the BT11 group (p < 0.05) but not in the placebo group. The cognitive
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enhancing effects were observed in both groups with SMI and MCI. But the statistically significant findings were only observed in the SMI group. Except for mild dyspepsia, no adverse event was occurred. Conclusions: BT-11 improved cognitive functions significantly in older people with SMI or MCI. Especially memory function was enhanced more greatly with BT-11 treatment than the placebo treatment. These results suggest that BT-11 might be a new functional food for the improvement of cognitive functions or the prevention of dementing process in people with SMI or MCI.
P.5.a.004 Validity of the Korean version of the Mini-Cog Y.M. Choi1 ° , D.W. Lee2 , J.Y. Lee3 . 1 Sanggyepaik Hospital, Inje University, Neuro-Psychiatry, Seoul, Republic of Korea; 2 Inje University, Psychiatry, Seoul, Republic of Korea; 3 Boramae Hospital, Psychiatry, Seoul, Republic of Korea Object: In Korea, the mean time from the onset of first symptom of dementia to first visit to clinic is about 2.7 years, much longer than the developed countries. As more treatments for dementia become available, screening for dementia in general medical practice becomes a mandate. But primary care physicians often do not screen patients because the tests take too long, they lack confidence in the method or in their own skills. To improve the detection and referral rate, the development of rapid and easy-touse screening tool which can be used routinely by primary care physicians is needed. The Mini-Cog is a rapid and easy-to-use screening tool which can be used by primary care physicians. The Mini-Cog uses a three-item recall test for memory and a simply scored clock-drawing test. In several different studies, the MiniCog was as effective or more effective than the MMSE and other established screening tests in both an epidemiological survey in a mainstream sample and a multi-ethnic, multilingual population comprising many individuals of low socioeconomic status and education level. We conducted a study to validate a Korean version of the Mini-Cog as a screening test for dementia which can be used by primary care physicians. Methods: Translation procedure: The Mini-Cog which is composed of delayed recall of 3 words and clock drawing test, was translated and back-translated by three Korean psychiatrists and two bilingual professionals. After several times of the revision of the Korean translation, the final form of the Korean version of Mini-Cog (Mini-Cog-K) was completed. Evaluation procedure: The Mini-Cog-K was applied to 116 elderly people who were living in community and 92 elderly people who were living in a nursing home. All subjects underwent the evaluation procedure composed of the following items. Clinical assessment battery of CERAD-K (Korean version of CERAD), Neuropsychological test battery of CERAD-K, The diagnosis of dementia was based on the Dementia of Alzheimer’s Type criteria of DSM-IV. Scoring of Mini-Cog-K: The total score of Mini-Cog is the sum of the scores of 3-item recall and clock drawing. 3-item recall task is scored as the numbers of correct recall. The clock drawing is scored as 2 for a normal drawing, and scored as 0 for an abnormal drawing. A Normal clock drawing has all of the following elements; All numbers 1−12, each only once, are present in the correct order and direction (clockwise), two hands are present, one pointing to 11 and one pointing to 2. Any clock drawing missing either of these elements is scored abnormal.
P.5.a Dementia and neurological disorders – Dementia disorders (clinical)
[2] Sheehan D.V., Lecrubier Y., Sheehan H.K. et al., 1998, The Mini International Neurospychiatric Interview (M.I.N.I) The Development and Validation of a Strudtured Diagnostic Psychiatric Interview for DSM-IV and ICD-10, Journal of Clinical Psychiatry, 59, suppl. 20, 22−33. [3] Spielberger C, 1983, Manual for the state-trait anxiety inventory, Revised edition, Palo Alto, Calif, Consulting Psychologists Press.
P.5 Dementia and neurological disorders P.5.a Dementia disorders (clinical) P.5.a.001 Galantamine in the treatment of Alzheimer’s disease K.L. Latalova, V. Pidrman ° . Palacky University Olomouc, Department of Psychiatry, Olomouc, Czech Republic Authors present results of a one-year open follow-up of galantamine efficacy and tolerability in the outpatient treatment of Alzheimer’s disease (AD). Diagnosis: psychiatric examination, NINCDS-ADRDA criteria. Efficacy was evaluated based on the assessment of cognitive functioning (MMSE scale) and activities of daily living (ADL) – DAD scale. Patients with AD – MMSE 16−20 without other serious disease. Efficacy was assessed prior to inclusion in the study and every 3 months (the end of months 3, 6, 9, 12) thereafter. Adverse effects were assessed every 2 weeks during the first and second month of treatment, than at the end of months 3, 6, 9, 12. Tolerability: assessment of blood pressure, heart rate and body weight changes; spontaneous patient/caregiver complaints of adverse effects during the treatment were also recorded. Therapy: patients received titrated doses of galantamine – first month 8 mg, from the beginning of second month 16 mg. No other psychoactive agents were used. 27 patients (20 women, 7 men) were included in the follow-up. 13 patients were at the age of 74 years or less (69.6, SD 3.55), 14 patients were older than 74 years (79.1, SD 2.82). Summary: 20 patients (74%) completed the 12 months followup. Four patients were excluded by the end of 9th month; 3 more patients by the end of the 12th month. Progression of the disease was the reasons for patient exclusion. Incidence of adverse effects was low – most common adverse effects presenting during the first few days of treatment and after the dose increase included: nausea, dizziness and headache. Adverse effects affected one fourth to one third of patients, but did not require any pharmacological assistance or reduction of galantamine dosage. No patient had to be excluded as a result of adverse effects. Changes of blood pressure and heart rate were not statistically significant during the follow-up. MMSE scores showed statistically significant (p = 0.01) increase in the whole sample from 17.3 (SD 1.52) to 19.0 (SD 2.39) at the end. DAD scores also showed statistically significant (p = 0.002) increase from 59.5 (SD 14.59) to 77.0 (SD 13.96). Classification of responders/non-responders: patients that showed improvement of MMSE during the one-year follow-up or patients without any change or patients with deterioration by not more than 1 point were classified as responders. 13 patients were as responders and 14 patients as non-responders. The difference in MMSE scores between responders and non-responders was statistically significant in the 6th month (p = 0.008). Non-responders showed MMSE values lower or similar to the initial examination. This is also true for DAD scores (p = 0.017). Evaluation of body weight showed significantly higher number of patients with unaltered or increased body weight in the group of responders.
Conclusion: The whole sample showed significant improvement, examination in the 6th month has a predictive value, responders did not loose their weight. Blood pressure and heart rate did not change.
P.5.a.002 Relationships between writing errors and cognitive impairment in elderly psychiatric patients S.C. Tamasan1 ° , D. Reisz2 . 1 Clinic Emergency Hospital, Psychiatry, Timisoara, Romania; 2 University of Medicine and Pharmacy “V Babes”, Neurology, Timisoara, Romania Objectives: to investigate if a brief easy to administer and to interpret writing test can assist in screening seniors with common psychopathology such as cognitive impairment, depressed or anxious mood. We expect to distinguish between cognitive impairment and depression and anxiety in this population, and to find writing markers for dementia. Methods: Forty four consecutive consenting patients seeking treatment at the outpatient psychiatric clinic of a general hospital (Clinic Emergency Hospital Timisoara, Romania) were assessed. The patients were 50 years of age or older, MMSE scores > 20, and had no other psychopathology but dementia (of Alzheimer or mixed type), mild cognitive disorder, and depression. There were excluded patients with major organic pathology, delirium, and poor medical condition. Cognitive performance and depressive and/or anxious symptoms were assessed using MMSE (Mini Mental State Examination) and Hamilton Rating Scale scores (21 items Hamilton Rating Scale for Depression respective 14 items Hamilton Anxiety Scale). Demographic data and subjective social support data were collected. Writing errors were assessed as following: writing of three self-elaborated sentences, copying a twenty-three words sentence, and timed. A writing error was considered: miss-punctuation, typos, repetitive or missing words, and incomprehensive syntax. Results: MMSE score grouped patients in nondemented (MMSE score 25−30) 28 (63.6%), and demented (MMSE score < 25) 16 (34.4%) patients. Thirteen patients (29.5%) manifested no anxiety, 21 (47.7%) mild anxiety (HAM-A score 18−24), and 10 (22.7%) moderate anxiety (based on HAM-A > 24). Eight (18.1%) patients manifested mild depression (scoring between 7 and 17 on 21 items HAM-D), 18 (40.9%) moderate depression (HAM-D score 18−24), and 17 (38.6%) severe depression (HAM-D > 24). The average duration of copying task was 131 seconds (range between 40 and 320 seconds). There was an inverse correlation between the time spent copying the text and MMSE score (−0.614 Pearson correlation) as well as an inverse correlation between MMSE and letters substitutions (−0.486). MMSE score inversely correlated with letters omissions (-0.542), inserted letters (−0.533), letter and word repetitions (−0.306) and showed a direct correlation with the lack of complexity of spontaneous elaborated sentences and incomprehensive syntax (0.372). There was no correlation with age (0.256), education (−0.110), subjective perceived social support (0.280). Depression score correlate mildly and positively only with age (0.324) and has no significant relation with social support and marital status. Conclusions: a quick, simple and accessible writing test can identify cases posing challenge in clinical daily practice: mild cognitive impairment, onset of dementia and depression. Using writing test we discover a set of dementia specific writing features, unrelated neither with anxious-depressive states nor with other
P.5.a Dementia and neurological disorders – Dementia disorders (clinical) demographic characteristics or social support. The copying task might assessed not simply the writing but also working memory, attention, visual scanning and also the complex understanding of a general meaning of the phrase.
P.5.a.003 Effect of functional diet BT-11 (Polygala tenuifolia Willdenow) on subjective memory impairment and mild cognitive impairment in older people S.H. Kim1 , H.Y. Jung2 ° , J.S. Yi3 , J.Y. Lee2 , K.Y. Shin4 , G.H. Lee4 , Y.H. Suh4 , Y.S. Kim5 . 1 Guro Hospital, College of Medicine Korea University, Psychiatry, Seoul, Republic of Korea; 2 Boramae Hospital, College of Medicine Seoul National University, Psychiatry, Seoul, Republic of Korea; 3 Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Psychiatry, Seoul, Republic of Korea; 4 College of Medicine Seoul National University, Pharmacology, Seoul, Republic of Korea; 5 Seoul National University College of Medicine, Seoul National University Hospital, Psychiatry, Seoul, Republic of Korea Background: Subjective memory impairment (SMI) and mild cognitive impairment (MCI) are often thought as transitional states from normal aging to dementia. Compared to healthy people, the risk of dementia increases fourfold and ten- to twentyfold in people with SMI and MCI, respectively. Therefore, it is needed to develop a new treatment strategy for improving the cognitive functions or preventing cognitive deterioration in this high risk population. Polygala tenuifolia has been known to inhibit the activity of acetylcholinesterase and the cytotoxicity of amyloid beta protein. It was developed as a functional diet for improving memory in Korea. We investigated whether the extract of dried root of Polygala tenuifolia Willdenow (BT-11) enhanced cognitive functions in elderly Korean people with SMI and MCI. Methods: Fifty three subjects (over sixty years old) with SMI (n = 35) and MCI (n = 18) were enrolled from the local mental community health center and Seoul National University Boramae Hospital. MCI was diagnosed by the Peterson’s criteria of mild cognitive impairment. All of the subjects completed an 8-week, randomized, double-blind, placebo-controlled trial. They were randomly assigned to one of the two groups taking 300 mg/d of BT-11 or placebo. We evaluated the cognitive functions of the subjects using the Korean versions of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet (CERAD-K) and the Mini-Mental Status Examination (MMSE-K) at baseline and after 8-week medication. The safety of BT-11 was examined by complete blood counting, blood chemistry, urinalysis and electrocardiogram. Between group comparison was made by t-test and Mann-Whitney test. Paired t-test was used for the comparison of clinical variables before and after medication. All statistical analyses were two-tailed, and a p-value of 0.05 was considered to be statistically significant. Summary of Results: The mean age of subject was 68.4 years. Eight were male and forty five were female. There were no significant differences in demographic variables and baseline cognitive functions between the two groups. In the BT-11 group (n = 28), the improvement of total scores of CERAD-K and MMSE-K was significantly higher than those in the placebo group (n = 25) (p = 0.003). In subscales of CERAD-K, the scores of word list learning, constructional praxis, constructional recall, and Boston naming test were improved significantly in the BT11 group (p < 0.05) but not in the placebo group. The cognitive
S477
enhancing effects were observed in both groups with SMI and MCI. But the statistically significant findings were only observed in the SMI group. Except for mild dyspepsia, no adverse event was occurred. Conclusions: BT-11 improved cognitive functions significantly in older people with SMI or MCI. Especially memory function was enhanced more greatly with BT-11 treatment than the placebo treatment. These results suggest that BT-11 might be a new functional food for the improvement of cognitive functions or the prevention of dementing process in people with SMI or MCI.
P.5.a.004 Validity of the Korean version of the Mini-Cog Y.M. Choi1 ° , D.W. Lee2 , J.Y. Lee3 . 1 Sanggyepaik Hospital, Inje University, Neuro-Psychiatry, Seoul, Republic of Korea; 2 Inje University, Psychiatry, Seoul, Republic of Korea; 3 Boramae Hospital, Psychiatry, Seoul, Republic of Korea Object: In Korea, the mean time from the onset of first symptom of dementia to first visit to clinic is about 2.7 years, much longer than the developed countries. As more treatments for dementia become available, screening for dementia in general medical practice becomes a mandate. But primary care physicians often do not screen patients because the tests take too long, they lack confidence in the method or in their own skills. To improve the detection and referral rate, the development of rapid and easy-touse screening tool which can be used routinely by primary care physicians is needed. The Mini-Cog is a rapid and easy-to-use screening tool which can be used by primary care physicians. The Mini-Cog uses a three-item recall test for memory and a simply scored clock-drawing test. In several different studies, the MiniCog was as effective or more effective than the MMSE and other established screening tests in both an epidemiological survey in a mainstream sample and a multi-ethnic, multilingual population comprising many individuals of low socioeconomic status and education level. We conducted a study to validate a Korean version of the Mini-Cog as a screening test for dementia which can be used by primary care physicians. Methods: Translation procedure: The Mini-Cog which is composed of delayed recall of 3 words and clock drawing test, was translated and back-translated by three Korean psychiatrists and two bilingual professionals. After several times of the revision of the Korean translation, the final form of the Korean version of Mini-Cog (Mini-Cog-K) was completed. Evaluation procedure: The Mini-Cog-K was applied to 116 elderly people who were living in community and 92 elderly people who were living in a nursing home. All subjects underwent the evaluation procedure composed of the following items. Clinical assessment battery of CERAD-K (Korean version of CERAD), Neuropsychological test battery of CERAD-K, The diagnosis of dementia was based on the Dementia of Alzheimer’s Type criteria of DSM-IV. Scoring of Mini-Cog-K: The total score of Mini-Cog is the sum of the scores of 3-item recall and clock drawing. 3-item recall task is scored as the numbers of correct recall. The clock drawing is scored as 2 for a normal drawing, and scored as 0 for an abnormal drawing. A Normal clock drawing has all of the following elements; All numbers 1−12, each only once, are present in the correct order and direction (clockwise), two hands are present, one pointing to 11 and one pointing to 2. Any clock drawing missing either of these elements is scored abnormal.