Prevalence of behavioral symptoms and associated caregiver burden in a group of Mexican patients with dementia

Poster Presentations P1 much work has been done on the mechanisms of Ab production and their cellular toxicities, transport mechanism(s) at the brain barriers underlying clearance of Ab remains unclear. The choroid plexus (CP) constitutes a barrier between the blood and cerebrospinal fluid (CSF) and functions to maintain the homeostasis of the internal milieu of the central nervous system. Previous study suggested that CP might play an important role in the development of the disease. In this study, an in vitro model by using CP cells is established to investgate the clearance mechanism of Ab. Methods: A two-chamber transport system by using a cultured CP cell line was established and Ab mobilization from the inner chamber to the outer chamber was analyzed by testing Ab levels between fluids in the inner and outer chambers. Results: As expected, a 215% more increase in the Ab levels was observed in the outer chamber, as compared to the decrease of Ab levels in the inner chamber, after 2 hours incubation of Ab autoantibodies purified from IVIG in the outer chamber. In contrast, no Ab mobilization was found when using IVIG that was depleted of Ab autoantibodies. Conclusions: Our results suggest that Ab can be mobilized through the CP layer and the in vitro CP model we have established can be used to study the clearance mechanism underlying the Ab mobilization from brain to blood and how Ab antibodies and other factors are involved. P1-039

PREVALENCE OF BEHAVIORAL SYMPTOMS AND ASSOCIATED CAREGIVER BURDEN IN A GROUP OF MEXICAN PATIENTS WITH DEMENTIA

Mario U. Perez Zepeda, Oscar Rosas Carrasco, Mariano Montan˜a Alvarez, Guadalupe Guerra Silla, Jorge A. Reyes Guerrero, Luis Miguel Gutierrez Robledo, Instituto Nacional de Ciencias Medicas y Nutricion, Mexico, Mexico. Contact e-mail: [email protected] Background: Behavioral symptoms are one of the most important factors associated with caregiver burden. They also have different patterns among distinct ethnic groups. Some clusters of symptoms tend to be more prevalent in certain patients. Because of the association of behavioral symptoms and caregiver burden, is important to know both prevalences. Methods: We interviewed 87 patients and their caregivers at the memory clinic of our institution. To measure behavioral symptoms we used Neuropsychiatric Index Questionnaire and for caregiver burden the Neuropsychiatric Index Distress Scale. The patients were previously classified according to DSM IV and expert consensus of the memory clinic, both de dementia diagnosis and the etiology. Both tools were validated previously in our population. We used descriptive statistics, with simple frequency as prevalence. Results: Of the 87 patients 65.5% (57) were women, and 82.8% of the caregiver wer also women. The mean age of the patients was 79.4 years, and 58.8 for the caregivers. The mean years of scholarship were 7. The main etiology of dementia was vascular dementia, 34.5%; followed by mixed type 29.9% and in third place Alzheimer´s disease 23%. The prevalence of any behavioral symptom for this study was 96.6% and for caregiver burden was of 80.5%. The more prevalent symptom was depression with 64.4% followed by apathy 63.2%. Conclusions: This brief report shows concordance with previous literature. The prevalence of behavioral symptoms in patients with dementia is very high, and has a tight relation with caregiver burden. P1-040

TYM TESTING

Jeremy M. Brown, George Pengas, Philip Clatworthy, Kate Dawson, Addenbrooke’s Hospital, Cambridge, United Kingdom. Contact e-mail: [email protected] Background: There is currently no cognitive screening test available for use by the non-specialist which combines 3 crucial features: Quick to use, Tests many domains, High sensitivity for detecting mild AD. We present a new test the TYM (Test Your Memory) which has these features. It tests 10 domains and is scored out of 50.The test is self administered under minimal supervision allowing thorough testing in minimal operator time. Methods: TYM test plus ACE-R were given to 540 normal controls age 18-95 years and 125 patients with degenerative dementias in a memory clinic. TYM test was validated with the MMSE and ACE-R. Results: Normal controls score 47/50 on the TYM until age 70, there is then a slight decline. Patients with AD (the majority with mild disease and at the time of diagnosis) score an av-

P183

erage of 33/50 on the TYM scoring particularly poorly on anterograde memory. At a cut-off of 42 the TYM detects 93% of cases of AD compared to 52% using the MMSE. There is strong correlation between ACE-R, MMSE and TYM. Conclusions: The TYM is a valid, quick and sensitive test to detect early AD. P1-041

A CASE REPORT OF ALZHEIMER DISEASE WITH PRESENILIN-1 MUTATION (MET233LEU) SHOWING A NEW PHENOTYPE

Masahiko Takaya1, Hiroaki Kazui1, Koji Ikezawa1, Ryu Kurimoto1, Kohichi Yamamoto2, Takashi Morihara1, Ryouhei Ishii1, Hiromasa Tokunaga1, Masatoshi Takeda1, 1Department of Psychiatry, Osaka University, Graduate School of Medicine, Suita, Japan; 2Department of Otolaryngology & Sensory Organ Surgery, Osaka University, Graduate School of Medicine, Suita, Japan. Contact e-mail: [email protected]. ac.jp Background: Two cases of the phenotypes (clinical symptoms and neuroimaging abnormalities) of early onset Alzheimer disease (AD) with presenilin-1 (PREN1) mutation (Met233Leu) have been reported. Both of the patients showed the core features of frontotemporal dementia (FTD) as well as those of AD. In both cases, images of MR and SPECT were not analyzed in detail. We have experienced a 38 years old female patient with familial AD associated with PREN1 mutation (Met233Leu). Methods: We comprehensively performed neuropsychological tests, neurological examinations and genetic examinations. In addition, we performed brain MRI and cerebrum blood perfusion SPECT, and statistically analyzed MRI data using VSRAD and SPECT data using 3D-SSP. Results: She showed memory impairment when she was 36 years old and the symptom gradually worsened. She came to our hospital two years later. At that time, she showed severe impairments of memory and visual-spatial perception. However, she had none of the core features of FTD; social unawareness or impropriety, abnormal personal regulation or apathy, emotional blunting, loss of empathy, and decreased insight. Her neurological tests revealed no abnormalities, including myoclonus, seizures, or spasticity. Her MMSE score was 12/30 at her first examination. At 16 months later, her MMSE score was 5/30. But even then she remembered her doctor’s name and face after one month interval, was aware of her memory impairment, and showed no features of FTD, nor myoclonus, seizure. In EEG, her basic rhythm is 6-7 Hz with frequent contaminations of 3-4 Hz slow waves. Her brain MR images showed no remarkable atrophy in all regions including hippocampus and parietal lobe. The VSRAD showed no atrophy in the parahippocampal gyrus. The 3DSSP showed remarkable regional hypoperfusion in the lateral frontal, parietal, precuneus, and posterior cingulated gyrus, but no hypoperfusion in the hippocampal, parahippocampal, and orbital gyri. A phenotype of this patient shows no features of FTD. APOE was 3/3, HLA-A was A31/A24, and KIBRA(rs17070145) was T/T. Conclusions: Our AD patient with PREN 1 mutation (Met233Leu) did not have any symptoms observed in FTD patients, unlike the other patients with the same mutation reported before. P1-042

PARKINSONISM VARIANT OF ALZHEIMER DISEASE WITH DLB: PRESENTING PSP-LIKE CLINICAL AND RADIOLOGICAL FINDINGS

Naoki Kasahata1,2, Nobutaka Arai3, Yoshihisa Makita2, 1Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan; 2Makita General Hospital, Tokyo, Japan; 3Tokyo Metropolitan Institute of Neuroscience, Tokyo, Japan. Contact e-mail: [email protected] Background: Estrapyramidal signs are previously reported relatively frequent in Alzheimer disease (AD). However, detailed clinical characters of such patients have not been described. Atrophy of midbrain tegmentum so called ‘‘hummingbird sign’’ has been diagnostic finding of progressive supranuclear palsy (PSP). There seems to be no report of hummingbird sign with other diagnosis. We encountered an AD with dementia with Lewy bodies (DLB) patient presenting parkinsonism. Methods: Clinical, radiological and neuropathological study. Results: A 75-year-old male admitted to the hospital because of pneumonia. At 65-year-old, he was unable to read newspapers but he behaved as he was able to read. At 67-yearld, he