- Email: [email protected]
PRISM registry: A novel tool to assess the prevalence of pseudobulbar affect symptoms in people with Alzheimer's disease
Poster Presentations: P4 P4-090
FREQUENCY AND CAUSES OF EARLY-ONSET DEMENTIA IN A TERTIARY REFERRAL CENTER IN ISTANBUL
Baris Topcular1, Neslihan Behrem2, Mesude Ozerden2, Ayca Altinkaya1, Nazan Karagoz Sakalli2, Dursun Kirbas2, Hasmet Hanagasi3, Murat Emre3, 1 Istanbul Bilim University Medical Faculty, Istanbul, Turkey; 2Bakirkoy Prof. Dr. Mazhar Osman Teaching and Research Hospital for Mental Health and Neurological Disorders, Istanbul, Turkey; 3Istanbul University Istanbul Medical Faculty, Istanbul, Turkey. Contact e-mail: [email protected] Background: Early-onset dementia (EOD) is defined as dementia that emerges before 65 years of age. EOD has been relatively less investigated compared to Late Onset Dementia (LOD). We aimed t o investigate the frequency and causes of early-onset dementia (EOD) in a tertiary referral dementia center in Istanbul, Turkey Methods: Patients referred to dementia unit were evaluated retrospectively. We evaluated the diagnosis, demographic characteristics of patients, and the disease course. Results: There were 296 patients with symptom onset before <65 years of age in a total of 3286 patients recorded in dementia unit database. 29, 3% of these patients had subjective memory or other cognitive complaints out of a total of 201 Early Onset Dementia (EOD) patients. The female to male ratio was 1, 07(151 females and 140 males). Mean years of education was 5, 37. Mean age at onset was 51,32 years. The most frequent etiologies were Alzheimer’s Disease (AD) (45, 6%) and Frontotemporal Dementia (FTD) (15,9%) . At the time of diagnosis mean MMSE score was 21, 2, Clinical Dementia Rating Scale was 1 in 69% of patients. Memory complaints were the most frequent reason of referral. In neuropscyhological assessment memory was the main cognitive deficit in 37, 4% of patients followed by executive dysfunction (30,7%). Gender ratio in EOD patients was similiar to that in Late Onset Dementia (LOD) patients. AD was less frequent in EOD compared to LOD patients whereas FTD had a higher frequency. Conclusions: Early Onset Dementia has features different than those seen in LOD. P4-091
DOES THERAPY FOR AN OVERACTIVE BLADDER HAVE AN EFFECT ON COGNITIVE FUNCTION?
Ece Esin1, Ali Ergen1, Mustafa Cankurtaran2, Burcu Yavuz1, Meltem Halil1, Zekeriya Ulger1, Yusuf Yesil1, MehmetEmin Kuyumcu1, Eylem Cankurtaran3, Servet Ariogul1, 1Hacettepe University, Ankara, Turkey; 2Hacettepe University Department of Internal Medicine Division of Geriatric Medicine, Ankara, Turkey; 3Ankara Oncology Hospital, Ankara, Turkey. Contact e-mail: [email protected] Background: Overactive bladder (OAB) and cognitive dysfunction are two important geriatric syndromes frequently seen in the geriatric population. OAB is defined as urgency, with or without urge incontinence, usually with frequency and nocturia. Anticholinergic therapy is the mainstay pharmacologic treatment for OAB. On the other hand, reduction in acetylcholine plays an important role in Alzheimer disease, the most common cause for dementia. Therefore, the physician dealing with geriatric population is challenged trying to balance maximum efficacy and minimum side effects. The aim of this study was to investigate the effects of different anticholinergic medications on cognitive function. Methods: 168 patients aged 65 years and over admitted to our Geriatric Medicine outpatient clinic with OAB were followed for 6 months. Overactive bladder was diagnosed according to International Continence Society definiton criteria. Exclusion criteria were to be on any anticholinergic medication before enrollment, genitourinary operation, history of frequent urinary tract infection. Patients were evaluated in 5 groups which were the group receiving only Kegel exercises and life style modifications, and the groups receiving one of 4 anticholinergic agents (Darifenasin, Oxybutynin, Tolterodine, and Trospium) in addition to exercise and life style modification. Patients were followed-up in a standardized protocol including routine visits at 2nd, 3rd and 6th months. Clock drawing test and Mini Mental State Examination test (MMSE) were performed to test cognitive function. Results: Median age of the study population was 73.5166.1, 156 (92.3%) were female and 11.9 % were diagnosed with dementia. MMSE scores of the total population before and after 6 moths therapy did not show significant difference (25.52 63.55 vs. 25.51 63.54, respectively; p¼0.91). However, in the dari-
P737
fenasin and oxybutynin groups, there was a slight but significant reduction in the post-treatment MMSE scores (p¼0.03 and 0.04, respectively). In patients who were diagnosed with dementia, no statistically significant decline in MMSE was observed (p¼0. 72). Conclusions: Although dementia and OAB coincide frequently in older adults, their treatments have conflicting features. According to the results of this study, antimuscarinic medications do not seem to impair cognitive function. Future randomized studies with larger group of patients and longer follow up are needed.
P4-092
PRISM REGISTRY: A NOVEL TOOL TO ASSESS THE PREVALENCE OF PSEUDOBULBAR AFFECT SYMPTOMS IN PEOPLE WITH ALZHEIMER’S DISEASE
David Crumpacker1, Jonathan Fellus2, Daniel Kantor3, Benjamin Rix Brooks4, Randall Kaye5, 1Baylor University Medical Center, Plano, Texas, United States; 2International Brain Research Foundation, Flanders, New Jersey, United States; 3Neurologique, Ponte Vedra Beach, Florida, United States; 4Carolinas Medical Center, Charlotte, North Carolina, United States; 5Avanir Pharmaceuticals, Inc., Aliso Viejo, California, United States. Contact e-mail: [email protected] Background: Pseudobulbar affect (PBA) is a neurologicalcondition characterized by uncontrollable, disruptive outbursts of laughingand/or crying; PBA occurs secondary to a variety of neurological conditions, including Alzheimer’s disease (AD). However, few studies have estimated prevalence of PBAsymptoms in patients with AD, and it is thought to be under-recognized in thisand other populations. ThePBA Registry Series (PRISM) was established to provide additional prevalence datafrom a "real world" clinic sample, including patients with AD. Methods: Following Institutional Review Board approval, participating sites wereasked to enroll 20 patients with any of 6 neurological conditions, includingAD. Patients (or their caregivers) completed the Center for NeurologicStudy-Lability Scale (CNS-LS) to screen for PBA symptoms; patients were notscreened for other psychiatric disorders. The CNS-LS is validated ascorresponding to physician diagnosis of PBA in patients with amyotrophiclateral sclerosis and multiple sclerosis at scores of 13 and 17, respectively; it has not yet been validated in patients with AD. For PRISM, presence of PBA symptomswas defined as a CNS-LS score 13. Additionally, patients (or their caregivers) rated the impact of their neurological condition on quality of life (QOL) usingan 11-point scale (0-10). Demographic data and current use ofantidepressant/antipsychotic medications were also recorded. Results: PRISM enrolled 5290 participants, of whom 1799(34%) had AD as a primary neurological condition, making it the registry’slargest disease group. The mean age of patients with AD was 79.2 years (SD9.75, median 81.0), 1124 (62.5%) were female, and 527 (29.3%) had PBA symptoms (CNSLS score 13). AD patients with CNS-LS 13 vs <13 reported greaterimpact of their neurological condition on QOL (6.4 vs 4.3; P<0.0001), and greater use of antipsychotics (8.7% vs 3.1%; P<0.0001), tricyclic (30.9% vs 15.5%;P<0.0001) and other antidepressants(38.3% vs 30.7%; P ¼0.002). Conclusions: PRISM is currently the largest clinic-based study to assess PBA symptom prevalence. PBA symptoms were common in AD and were associated with impaired QOL and greater use of antipsychotic/ antidepressant medications. These data underscore a need for greater recognition and assessment of PBA in patients with AD and other at-risk neurological conditions.
P4-093
EMOTIONAL RECOGNITION OF UNRECOGNIZED VISUAL STIMULI IN A PERSON WITH POSTERIOR CORTICAL ATROPHY
Marıa Luz Gonzalez-Gadea1, Juliane Damm2, Pablo Richly1, Carlos Gelormini-Lezama1, Facundo Manes1, Agustın Iba~nez1, Maria Roca1, 1INECO, Buenos Aires, Argentina; 2University of Leipzig, Leipzig, Germany. Contact e-mail: [email protected] Background: Non-conscious visual recognition has been described in patients with visual agnosia, indicating the existence of some kind of "pre-
FREQUENCY AND CAUSES OF EARLY-ONSET DEMENTIA IN A TERTIARY REFERRAL CENTER IN ISTANBUL
Baris Topcular1, Neslihan Behrem2, Mesude Ozerden2, Ayca Altinkaya1, Nazan Karagoz Sakalli2, Dursun Kirbas2, Hasmet Hanagasi3, Murat Emre3, 1 Istanbul Bilim University Medical Faculty, Istanbul, Turkey; 2Bakirkoy Prof. Dr. Mazhar Osman Teaching and Research Hospital for Mental Health and Neurological Disorders, Istanbul, Turkey; 3Istanbul University Istanbul Medical Faculty, Istanbul, Turkey. Contact e-mail: [email protected] Background: Early-onset dementia (EOD) is defined as dementia that emerges before 65 years of age. EOD has been relatively less investigated compared to Late Onset Dementia (LOD). We aimed t o investigate the frequency and causes of early-onset dementia (EOD) in a tertiary referral dementia center in Istanbul, Turkey Methods: Patients referred to dementia unit were evaluated retrospectively. We evaluated the diagnosis, demographic characteristics of patients, and the disease course. Results: There were 296 patients with symptom onset before <65 years of age in a total of 3286 patients recorded in dementia unit database. 29, 3% of these patients had subjective memory or other cognitive complaints out of a total of 201 Early Onset Dementia (EOD) patients. The female to male ratio was 1, 07(151 females and 140 males). Mean years of education was 5, 37. Mean age at onset was 51,32 years. The most frequent etiologies were Alzheimer’s Disease (AD) (45, 6%) and Frontotemporal Dementia (FTD) (15,9%) . At the time of diagnosis mean MMSE score was 21, 2, Clinical Dementia Rating Scale was 1 in 69% of patients. Memory complaints were the most frequent reason of referral. In neuropscyhological assessment memory was the main cognitive deficit in 37, 4% of patients followed by executive dysfunction (30,7%). Gender ratio in EOD patients was similiar to that in Late Onset Dementia (LOD) patients. AD was less frequent in EOD compared to LOD patients whereas FTD had a higher frequency. Conclusions: Early Onset Dementia has features different than those seen in LOD. P4-091
DOES THERAPY FOR AN OVERACTIVE BLADDER HAVE AN EFFECT ON COGNITIVE FUNCTION?
Ece Esin1, Ali Ergen1, Mustafa Cankurtaran2, Burcu Yavuz1, Meltem Halil1, Zekeriya Ulger1, Yusuf Yesil1, MehmetEmin Kuyumcu1, Eylem Cankurtaran3, Servet Ariogul1, 1Hacettepe University, Ankara, Turkey; 2Hacettepe University Department of Internal Medicine Division of Geriatric Medicine, Ankara, Turkey; 3Ankara Oncology Hospital, Ankara, Turkey. Contact e-mail: [email protected] Background: Overactive bladder (OAB) and cognitive dysfunction are two important geriatric syndromes frequently seen in the geriatric population. OAB is defined as urgency, with or without urge incontinence, usually with frequency and nocturia. Anticholinergic therapy is the mainstay pharmacologic treatment for OAB. On the other hand, reduction in acetylcholine plays an important role in Alzheimer disease, the most common cause for dementia. Therefore, the physician dealing with geriatric population is challenged trying to balance maximum efficacy and minimum side effects. The aim of this study was to investigate the effects of different anticholinergic medications on cognitive function. Methods: 168 patients aged 65 years and over admitted to our Geriatric Medicine outpatient clinic with OAB were followed for 6 months. Overactive bladder was diagnosed according to International Continence Society definiton criteria. Exclusion criteria were to be on any anticholinergic medication before enrollment, genitourinary operation, history of frequent urinary tract infection. Patients were evaluated in 5 groups which were the group receiving only Kegel exercises and life style modifications, and the groups receiving one of 4 anticholinergic agents (Darifenasin, Oxybutynin, Tolterodine, and Trospium) in addition to exercise and life style modification. Patients were followed-up in a standardized protocol including routine visits at 2nd, 3rd and 6th months. Clock drawing test and Mini Mental State Examination test (MMSE) were performed to test cognitive function. Results: Median age of the study population was 73.5166.1, 156 (92.3%) were female and 11.9 % were diagnosed with dementia. MMSE scores of the total population before and after 6 moths therapy did not show significant difference (25.52 63.55 vs. 25.51 63.54, respectively; p¼0.91). However, in the dari-
P737
fenasin and oxybutynin groups, there was a slight but significant reduction in the post-treatment MMSE scores (p¼0.03 and 0.04, respectively). In patients who were diagnosed with dementia, no statistically significant decline in MMSE was observed (p¼0. 72). Conclusions: Although dementia and OAB coincide frequently in older adults, their treatments have conflicting features. According to the results of this study, antimuscarinic medications do not seem to impair cognitive function. Future randomized studies with larger group of patients and longer follow up are needed.
P4-092
PRISM REGISTRY: A NOVEL TOOL TO ASSESS THE PREVALENCE OF PSEUDOBULBAR AFFECT SYMPTOMS IN PEOPLE WITH ALZHEIMER’S DISEASE
David Crumpacker1, Jonathan Fellus2, Daniel Kantor3, Benjamin Rix Brooks4, Randall Kaye5, 1Baylor University Medical Center, Plano, Texas, United States; 2International Brain Research Foundation, Flanders, New Jersey, United States; 3Neurologique, Ponte Vedra Beach, Florida, United States; 4Carolinas Medical Center, Charlotte, North Carolina, United States; 5Avanir Pharmaceuticals, Inc., Aliso Viejo, California, United States. Contact e-mail: [email protected] Background: Pseudobulbar affect (PBA) is a neurologicalcondition characterized by uncontrollable, disruptive outbursts of laughingand/or crying; PBA occurs secondary to a variety of neurological conditions, including Alzheimer’s disease (AD). However, few studies have estimated prevalence of PBAsymptoms in patients with AD, and it is thought to be under-recognized in thisand other populations. ThePBA Registry Series (PRISM) was established to provide additional prevalence datafrom a "real world" clinic sample, including patients with AD. Methods: Following Institutional Review Board approval, participating sites wereasked to enroll 20 patients with any of 6 neurological conditions, includingAD. Patients (or their caregivers) completed the Center for NeurologicStudy-Lability Scale (CNS-LS) to screen for PBA symptoms; patients were notscreened for other psychiatric disorders. The CNS-LS is validated ascorresponding to physician diagnosis of PBA in patients with amyotrophiclateral sclerosis and multiple sclerosis at scores of 13 and 17, respectively; it has not yet been validated in patients with AD. For PRISM, presence of PBA symptomswas defined as a CNS-LS score 13. Additionally, patients (or their caregivers) rated the impact of their neurological condition on quality of life (QOL) usingan 11-point scale (0-10). Demographic data and current use ofantidepressant/antipsychotic medications were also recorded. Results: PRISM enrolled 5290 participants, of whom 1799(34%) had AD as a primary neurological condition, making it the registry’slargest disease group. The mean age of patients with AD was 79.2 years (SD9.75, median 81.0), 1124 (62.5%) were female, and 527 (29.3%) had PBA symptoms (CNSLS score 13). AD patients with CNS-LS 13 vs <13 reported greaterimpact of their neurological condition on QOL (6.4 vs 4.3; P<0.0001), and greater use of antipsychotics (8.7% vs 3.1%; P<0.0001), tricyclic (30.9% vs 15.5%;P<0.0001) and other antidepressants(38.3% vs 30.7%; P ¼0.002). Conclusions: PRISM is currently the largest clinic-based study to assess PBA symptom prevalence. PBA symptoms were common in AD and were associated with impaired QOL and greater use of antipsychotic/ antidepressant medications. These data underscore a need for greater recognition and assessment of PBA in patients with AD and other at-risk neurological conditions.
P4-093
EMOTIONAL RECOGNITION OF UNRECOGNIZED VISUAL STIMULI IN A PERSON WITH POSTERIOR CORTICAL ATROPHY
Marıa Luz Gonzalez-Gadea1, Juliane Damm2, Pablo Richly1, Carlos Gelormini-Lezama1, Facundo Manes1, Agustın Iba~nez1, Maria Roca1, 1INECO, Buenos Aires, Argentina; 2University of Leipzig, Leipzig, Germany. Contact e-mail: [email protected] Background: Non-conscious visual recognition has been described in patients with visual agnosia, indicating the existence of some kind of "pre-