- Email: [email protected]
Proxies of cognitive reserve and their cerebral correlates in prodromal and mild Alzheimer's disease: An ongoing FDG-PET study
Poster Presentations: P1
our study was to investigate this effect with respect to cerebral changes by using 18F-fluoro-deoxy-glucose positron emission tomography (FDG-PET). Methods: 29 patients with MCI and mild AD were shown positive and neutral pictures in a free recall-task. According to the respective results, the group was dichotomized into subgroups with a pronounced (mean age: 71.8; SD: 5.9; 11 women, 4 men) vs. a blurred (mean age: 73.5; SD: 4.6; 6 women, 8 men) positivity effect. To investigate the cerebral correlates of the positivity effect, FDG-PET scans obtained in the subgroups were compared by using SPM 8 with severity of cognitive impairment (MMSE scores) as a covariate. Results: Patients with positivity effect show a significantly higher glucose uptake in the right occipital gyrus and the left cuneus; the right medial and the left superior frontal gyrus as well as in the right parahippocampal gyrus and left insula compared with patients without positivity effect. Conclusions: The results of our ongoing study confirm the positivity effect in patients with MCI and mild AD and demonstrate that this effect involves the cuneus, limbic and frontal regions. These findings lead to the hypothesis that the positivity effect involves a compensatory role of an emotion network in memory performance.
P1-185
PREVALENCE AND CLINICAL CHARACTERISTICS OF MIXED DEMENTIA IN ELDERLY MEXICANS
Alberto Jose Mimenza1, Cesar Moreno1, Sara Gloria Aguilar1, Jose Alberto Avila2, Pedro Alvarado1, 1Instituto Nacional de Ciencias Medicas y Nutrici on Salvador Subiran, Mexico City, Mexico; 2Instituto Nacional de Ciencias Medicas y Nutricion Salvador Subiran, Mexico City, Mexico. Contact e-mail: [email protected] Background: Alzheimer’s Disease (AD) is the main cause of dementia worldwide, however some studies had shown that combination of degenerative components with vascular factors is the most common cause of cognitive decline in elderly. The literature on Mixed Dementia (MD) is limited, there is still no consensus or diagnostic criteria for its study, diagnosis and management. Methods: We examined patients of our Memory Clinic between January 2010 and September 2014. Subjects diagnosed with MD and AD were analyzed for differences in the characteristics of each group. Later univariate and multivariate analysis was performed to determine associated factors with M. Results: 225 subjects were included of which 137 had MD diagnosis and 88 AD. Mean (SD) age was 82.9 (66.83) years, with 9.5(66.33) years of education, 116 (51.5%) women. In comparison with AD, subjects with MD had a higher mean age (83.94 vs 81.82 years, p value ¼ 0.033), more subjects with diabetes (48.17% vs 31.8%, p ¼ 0.017), hypertension (69.34% vs 53.4%, p ¼ 0.022), dyslipidemia (67.88% vs 52.3%, p ¼ 0.022), vitamin B12 deficit (8.76% vs 1.1%, p ¼ 0.016), history of stroke (24.81% vs 8.76%, p ¼ 0.015); and less subjects with family history of dementia (8.75% vs 21.6%, p ¼ 0.017) and resolved depression (10.92% vs 18.18%, p ¼ 0.035). The imaging findings showed higher prevalence of leukoaraiosis, lacunar infarcts, and previous infarctions in CT (p ¼ 0.016), and increased subcortical atrophy, white matter lesions, lacunar infarcts and even acute infarcts in MR (p < 0.001). Strongest association factors with MD in univariate and multivariate analyzes were hypertension (OR 1.92, p ¼ 0.009), white matter lesions (OR 3.61, p < 0.001) and lacunar infarcts (OR 3.35, p ¼ 0.014), resolved depression shown
P417
inverse relationship (OR 0.11, p ¼ 0.004). Conclusions: MD is the leading cause of dementia in our population and is strongly related to vascular risk factors. The characterization of MD and its timely diagnosis with a better control of cardiovascular factors could modify its course.
P1-186
PROXIES OF COGNITIVE RESERVE AND THEIR CEREBRAL CORRELATES IN PRODROMAL AND MILD ALZHEIMER’S DISEASE: AN ONGOING FDG-PET STUDY
Nadja Urbanowitsch1, Magdalena Eva Kowoll1, Christina Josefa Herold1, Anika K€untzelmann2, Frederik Giesel3, Uwe Haberkorn3, Peter Sch€onknecht4,5, Johannes Schr€oder1,6, 1Section of Geriatric Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; 2 Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany; 3Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany; 4LIFE – Leipzig Research Center for Civilization Diseases, Leipzig, Germany; 5Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany; 6Section of Geriatric Psychiatry, University Hospital Heidelberg; Institute of Gerontology, University of Heidelberg, Heidelberg, Germany. Contact e-mail: [email protected] Background: Cognitive reserve can compensate for cerebral changes in prodromal and mild Alzheimer’s disease (AD) and can be defined by a variety of proxies. Perhaps the most commonly used proxy measures is education followed by occupational complexity. Although generally conserved in AD, reading ability (or literacy) was only applied in some studies. We investigated these proxies with respect to cerebral changes as assessed by 18F-fluoro-deoxy-glucose positron emission tomography (FDGPET) scans with SPM8. Methods: Up to now, 20 patients with prodromal AD (mean age: 72.161.4), 25 patients with mild AD (mean age: 73.761.2) and 10 cognitive normal controls (mean age: 69.262.2) were included. Education was operationalized by years of school education, occupational complexity according to a representative survey (DEGS1) in Germany, and reading abilities on the WST. The patient group was dichotomized accordingly and subgroups with low vs. high cognitive reserve compared for cerebral changes as visualized by FDG-PET. MMSE scores were entered as a covariate. Results: The prodromal and mild AD patients presented with a significantly reduced glucose uptake in the cingulum and the precuneus than the controls. Within the prodromal AD group, patients with a high reserve (more educational years) showed a significantly lower glucose uptake in the right superior and inferior parietal and left superior frontal lobe while the mild patients with a high reserve showed significantly lower values in the right cuneus and insula as well as left frontal and occipital areas. Similar albeit more pronounced differences were found when occupation was used as a proxy for cognitive reserve. In contrast, the definition of cognitive reserve according to reading abilities led to a different pattern involving left and right occipital areas and the right parahippocampus. Conclusions: The results of our ongoing study support the hypothesis that cognitive reserve can compensate brain changes in both prodromal and mild AD. The correlates of cognitive reserve identified by FDG-PET do not compare with those which differentiate patients with AD from controls. This finding indicates that cognitive reserve involves compensatory processes rather than direct effects on the cerebral changes which lead to the disorder.
our study was to investigate this effect with respect to cerebral changes by using 18F-fluoro-deoxy-glucose positron emission tomography (FDG-PET). Methods: 29 patients with MCI and mild AD were shown positive and neutral pictures in a free recall-task. According to the respective results, the group was dichotomized into subgroups with a pronounced (mean age: 71.8; SD: 5.9; 11 women, 4 men) vs. a blurred (mean age: 73.5; SD: 4.6; 6 women, 8 men) positivity effect. To investigate the cerebral correlates of the positivity effect, FDG-PET scans obtained in the subgroups were compared by using SPM 8 with severity of cognitive impairment (MMSE scores) as a covariate. Results: Patients with positivity effect show a significantly higher glucose uptake in the right occipital gyrus and the left cuneus; the right medial and the left superior frontal gyrus as well as in the right parahippocampal gyrus and left insula compared with patients without positivity effect. Conclusions: The results of our ongoing study confirm the positivity effect in patients with MCI and mild AD and demonstrate that this effect involves the cuneus, limbic and frontal regions. These findings lead to the hypothesis that the positivity effect involves a compensatory role of an emotion network in memory performance.
P1-185
PREVALENCE AND CLINICAL CHARACTERISTICS OF MIXED DEMENTIA IN ELDERLY MEXICANS
Alberto Jose Mimenza1, Cesar Moreno1, Sara Gloria Aguilar1, Jose Alberto Avila2, Pedro Alvarado1, 1Instituto Nacional de Ciencias Medicas y Nutrici on Salvador Subiran, Mexico City, Mexico; 2Instituto Nacional de Ciencias Medicas y Nutricion Salvador Subiran, Mexico City, Mexico. Contact e-mail: [email protected] Background: Alzheimer’s Disease (AD) is the main cause of dementia worldwide, however some studies had shown that combination of degenerative components with vascular factors is the most common cause of cognitive decline in elderly. The literature on Mixed Dementia (MD) is limited, there is still no consensus or diagnostic criteria for its study, diagnosis and management. Methods: We examined patients of our Memory Clinic between January 2010 and September 2014. Subjects diagnosed with MD and AD were analyzed for differences in the characteristics of each group. Later univariate and multivariate analysis was performed to determine associated factors with M. Results: 225 subjects were included of which 137 had MD diagnosis and 88 AD. Mean (SD) age was 82.9 (66.83) years, with 9.5(66.33) years of education, 116 (51.5%) women. In comparison with AD, subjects with MD had a higher mean age (83.94 vs 81.82 years, p value ¼ 0.033), more subjects with diabetes (48.17% vs 31.8%, p ¼ 0.017), hypertension (69.34% vs 53.4%, p ¼ 0.022), dyslipidemia (67.88% vs 52.3%, p ¼ 0.022), vitamin B12 deficit (8.76% vs 1.1%, p ¼ 0.016), history of stroke (24.81% vs 8.76%, p ¼ 0.015); and less subjects with family history of dementia (8.75% vs 21.6%, p ¼ 0.017) and resolved depression (10.92% vs 18.18%, p ¼ 0.035). The imaging findings showed higher prevalence of leukoaraiosis, lacunar infarcts, and previous infarctions in CT (p ¼ 0.016), and increased subcortical atrophy, white matter lesions, lacunar infarcts and even acute infarcts in MR (p < 0.001). Strongest association factors with MD in univariate and multivariate analyzes were hypertension (OR 1.92, p ¼ 0.009), white matter lesions (OR 3.61, p < 0.001) and lacunar infarcts (OR 3.35, p ¼ 0.014), resolved depression shown
P417
inverse relationship (OR 0.11, p ¼ 0.004). Conclusions: MD is the leading cause of dementia in our population and is strongly related to vascular risk factors. The characterization of MD and its timely diagnosis with a better control of cardiovascular factors could modify its course.
P1-186
PROXIES OF COGNITIVE RESERVE AND THEIR CEREBRAL CORRELATES IN PRODROMAL AND MILD ALZHEIMER’S DISEASE: AN ONGOING FDG-PET STUDY
Nadja Urbanowitsch1, Magdalena Eva Kowoll1, Christina Josefa Herold1, Anika K€untzelmann2, Frederik Giesel3, Uwe Haberkorn3, Peter Sch€onknecht4,5, Johannes Schr€oder1,6, 1Section of Geriatric Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; 2 Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany; 3Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany; 4LIFE – Leipzig Research Center for Civilization Diseases, Leipzig, Germany; 5Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany; 6Section of Geriatric Psychiatry, University Hospital Heidelberg; Institute of Gerontology, University of Heidelberg, Heidelberg, Germany. Contact e-mail: [email protected] Background: Cognitive reserve can compensate for cerebral changes in prodromal and mild Alzheimer’s disease (AD) and can be defined by a variety of proxies. Perhaps the most commonly used proxy measures is education followed by occupational complexity. Although generally conserved in AD, reading ability (or literacy) was only applied in some studies. We investigated these proxies with respect to cerebral changes as assessed by 18F-fluoro-deoxy-glucose positron emission tomography (FDGPET) scans with SPM8. Methods: Up to now, 20 patients with prodromal AD (mean age: 72.161.4), 25 patients with mild AD (mean age: 73.761.2) and 10 cognitive normal controls (mean age: 69.262.2) were included. Education was operationalized by years of school education, occupational complexity according to a representative survey (DEGS1) in Germany, and reading abilities on the WST. The patient group was dichotomized accordingly and subgroups with low vs. high cognitive reserve compared for cerebral changes as visualized by FDG-PET. MMSE scores were entered as a covariate. Results: The prodromal and mild AD patients presented with a significantly reduced glucose uptake in the cingulum and the precuneus than the controls. Within the prodromal AD group, patients with a high reserve (more educational years) showed a significantly lower glucose uptake in the right superior and inferior parietal and left superior frontal lobe while the mild patients with a high reserve showed significantly lower values in the right cuneus and insula as well as left frontal and occipital areas. Similar albeit more pronounced differences were found when occupation was used as a proxy for cognitive reserve. In contrast, the definition of cognitive reserve according to reading abilities led to a different pattern involving left and right occipital areas and the right parahippocampus. Conclusions: The results of our ongoing study support the hypothesis that cognitive reserve can compensate brain changes in both prodromal and mild AD. The correlates of cognitive reserve identified by FDG-PET do not compare with those which differentiate patients with AD from controls. This finding indicates that cognitive reserve involves compensatory processes rather than direct effects on the cerebral changes which lead to the disorder.