- Email: [email protected]
Religious dogmatism in neurodegenerative disease
P750
Poster Presentations: P4
Marcio Balthazar7, Benito Damasceno8, Cassio Bottino9, Sonia Brucki10, Ricardo Nitrini1, 1University of S~ao Paulo, S~ao Paulo, Brazil; 2School of Medicine of the University of S~ao Paulo, S~ao Paulo, Brazil; 3School of Medicine of the University of S~ao Paulo, S~ao Paulo, Brazil; 4Federal University of Minas Gerais, Belo Horizonte - Minas Gerais, Brazil; 5 Federal University of Minas Gerais, Belo Horizonte – Minas Gerais, Brazil; 6Federal University of Minas Gerais, Beo Horizonte-MG, Brazil; 7 State University of Campinas, Campinas, Brazil; 8Unicamp, Campinas, ao Paulo, S~ao Paulo, Brazil; 10HCFMUSP - Hospital Brazil; 9University of S~ Santa Marcelina, S~ ao Paulo, Brazil. Contact e-mail: [email protected] Background: There is limited information regarding the functional profile of individuals diagnosed with bvFTD and the best strategy to assess functional impairment in these patients. The objetive of the study was to compare direct (based on observed performance) and indirect (based on questionnaires answered by caregiver) methods of functional assessment in bvFTD. Methods: The sample consisted of 96 individuals aged 45 or older, with at least two years of formal education, 31 had been diagnosed with bvFTD, 31 with AD, and 34 were healthy adults paired with the other participants for age and education. Patients were paired for disease severity. The protocol included: sociodemographic and clinical questionnaire; 15item Geriatric Depression Scale (GDS); Geriatric Anxiety Inventory (GAI); Addenbrooke Cognitive Examination-Revised (ACE-R), which includes the questions of the Mini Mental State Examination (MMSE); Executive Interview (EXIT-25); and the Direct Assessment of Functional Status (DAFS-BR). The protocol for caregivers included the Cornell Scale for Depression in Dementia, Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI) and the Clinical Dementia Rating scale (CDR). Results: In both diagnostic groups DAFS-BR scores correlated significantly with DAD scores (AD: rho¼0.48, p<0.006; bvFTD: rho¼0.56, p<0.001). In the bvFTD group, DAFS-BR and DAD scores were strongly correlated with all cognitive tests but exhibited no associations with neuropsychiatric symptoms. The DAD (indirect assessment) had higher accuracy to distinguish bvFTD from AD (AUC¼0.78, sensitivity¼0.71, specificity¼0.71) than the DAFS-BR, based on direct assessment (AUC¼0.60, sensitivity¼0.55, specificity¼0.65). Conclusions: Results suggest functional impairment in bvFTD, assessed directly or indirectly, is highly associated with cognitive impairment. Direct and indirect assessments of functional deficits in bvFTD seem to contribute to the differential diagnosis between AD and bvFTD, although the DAD exhibited higher accuracy to distinguish the groups. P4-127
RELIGIOUS DOGMATISM IN NEURODEGENERATIVE DISEASE
Nikolas Block1, David Perry1, Virginia Sturm1, Zachary Miller1, Bruce Miller2, 1UCSF Memory and Aging Center, San Francisco, California, United States; 2UCSF Memory and Aging Center, San Francisco, California, United States. Contact e-mail: [email protected]. edu Background: The emergence of religious dogmatism, or hyper-religiosity, in neurodegenerative disease has been previously described but prevalence and attributes by diagnosis are not well characterized. Limbic and paralimbic brain regions, including temporal and orbitofrontal cortex, have been implicated in religious dogmatism and are selectively affected in frontotemporal lobar degenerative disorders. Methods: We examined a large cohort (N¼1607) of patients which included behavioral variant frontotemporal dementia (bvFTD; n¼87), semantic variant primary progressive aphasia (svPPA; n¼57), Alzheimer’s disease (AD; n¼237) and normal controls (NC; n¼587) from the UCSF Memory and Aging Center and identified participants with a clinician-rated feature of religious dogmatism. Rates of mental rigidity were also noted. We hypothesized there would be higher rates ofreligious dogmatism in the bvFTD and svPPA groups as compared to NC and AD, and that dogmatic patients with bvFTD/svPPA would also have higher rates of mental rigidity. Results: We identified a total of 35 participants who were rated by clinicians as exhibiting religious dogmatism: 12 patients with bvFTD, 6patients with svPPA, 2 patients with AD, and 4 NCs. Planned odds ratios were then per-
formed to compare rates of religious dogmatism between diagnostic pairs. There were significantly higher rates of religious dogmatism in bvFTD vs. NC (OR ¼23.32, p<.001), svPPA vs. NC (OR ¼17.14, p<.001), bvFTD vs. AD (OR ¼18.80, p<.001), and svPPA vs. AD (OR ¼13.82, p<.001). Rates of dogmatism in bvFTD vs. svPPA (OR ¼1.36, p ¼.616) and AD vs. NC (OR¼1.24, p ¼.553) were not significantly different. Patients with bvFTD/svPPA who were religiously dogmatic (n¼18) had higher rates of mental rigidity than those patients who were not dogmatic (n¼109), OR ¼9.25, p<.001. Conclusions: Our results find significantly higher rates of religious dogmatism in bvFTD and svPPA as compared to NC and AD, and that religious dogmatism in these patients is associated with higher rates of mental rigidity. This study suggests the selective degeneration of neural systems important for cognitive flexibility in bvFTD and svPPA may be associated with increased dogmatic beliefs in the context of religion.
P4-128
UNDERDIAGNOSIS OF COGNITIVE IMPAIRMENT: RESULTS FROM A POSTMORTEM STUDY
Renata Ferretti-Rebustini1, Ricardo Nitrini2, Lea T. Grinberg3, Renata Leite3, Claudia Suemoto1, Jose Farfel4, Carlos Pasqualucci4, Wilson Jacob-Filho5, 1University of S~ao Paulo Medical School, S~ao Paulo, Brazil; 2University of S~ao Paulo, S~ao Paulo, Brazil; 3University of S~ao Paulo Medical School, S~ao Paulo, Brazil; 4University of S~ao Paulo Medical School, S~ao Paulo, Brazil; 5University of S~ao Paulo, S~ao Paulo, Brazil. Contact e-mail: [email protected] Background: The frequency of underdiagnosis of dementia in Brazil is difficult to estimate. Postmortem studies can contribute to obtain data on this matter. The objective of the present study was to identify the number of cases with cognitive impairment submitted to autopsy that had been diagnosed in life, according to the severity of cognitive impairment and neuropathological diagnosis. Methods: Data was extracted from the Brazilian Brain Bank of the Aging Brain Study Group (BBBABSG) database, in the period of 2005 to 2006. In this period, the subset of people who died in the metropolitan area of S~ao Paulo and were submitted to autopsy in the SPAS were assessed, after informed consent. Cognitive assessment in the BBBABSG was obtained by the CDR application to a reliable informant. Neuropathology followed the BBBABSG criteria. Age, gender and scores of CDR were extracted from the records. Data was analyzed descriptively, as for total frequency and in each gender. Results: Samples was composed by 252 cases, mostly females (50.8%) with mean age of 73.35611.59 yo. Concerning the cognitive impairment, 62.0% of the subjects had no cognitive impairment (CDR 0) and 38.0% were cognitively impaired (CDR 0.5 13.6%; CDR 1 - 7.9%; CDR 2 - 7.0%; CDR 3 - 9.5%. Dementia was diagnosed before death in 23/59 cases (39.0%). Only 8/26 of AD cases were diagnosed before death. (30.8%). Underdiagnosis was also frequent in Mixed Dementia Cases (11/ 31; 64,.5%) and Vascular Dementia (1/18; 94.4%.). Conclusions: Underdiagnosis of dementia is frequent in Brazil.
P4-129
MULTICENTER SUBCORTICAL VASCULAR DEMENTIA ON FDG-PET (VADAPET) STUDY SIGNIFIES MORE POSTERIOR NETWORK HYPOMETABOLISM
Jee-Hyang Jeong1, Sang Soo Cho2, Duk L. Na3, Seol-Heui Han4, 1Ewha Womans University Mokdong Hospital, Seoul, South Korea; 2CAMH, Toronto, Canada; 3Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; 4Konkuk University Medical Center, Seoul, South Korea. Contact e-mail: [email protected] Background: Subcortical vascular dementia (SVD), one of the multi-factorial and multi-pathophysiologic vascular dementias, is a dementia associated with multiple small vessel changes or lacunes in white matter (Binswanger type) or deep nuclei (lacunar type). The aim of the current study is to identify brain regions with glucose hypometabolism in FDGPET using an SPM analysis in patients with SVD recruited from
Poster Presentations: P4
Marcio Balthazar7, Benito Damasceno8, Cassio Bottino9, Sonia Brucki10, Ricardo Nitrini1, 1University of S~ao Paulo, S~ao Paulo, Brazil; 2School of Medicine of the University of S~ao Paulo, S~ao Paulo, Brazil; 3School of Medicine of the University of S~ao Paulo, S~ao Paulo, Brazil; 4Federal University of Minas Gerais, Belo Horizonte - Minas Gerais, Brazil; 5 Federal University of Minas Gerais, Belo Horizonte – Minas Gerais, Brazil; 6Federal University of Minas Gerais, Beo Horizonte-MG, Brazil; 7 State University of Campinas, Campinas, Brazil; 8Unicamp, Campinas, ao Paulo, S~ao Paulo, Brazil; 10HCFMUSP - Hospital Brazil; 9University of S~ Santa Marcelina, S~ ao Paulo, Brazil. Contact e-mail: [email protected] Background: There is limited information regarding the functional profile of individuals diagnosed with bvFTD and the best strategy to assess functional impairment in these patients. The objetive of the study was to compare direct (based on observed performance) and indirect (based on questionnaires answered by caregiver) methods of functional assessment in bvFTD. Methods: The sample consisted of 96 individuals aged 45 or older, with at least two years of formal education, 31 had been diagnosed with bvFTD, 31 with AD, and 34 were healthy adults paired with the other participants for age and education. Patients were paired for disease severity. The protocol included: sociodemographic and clinical questionnaire; 15item Geriatric Depression Scale (GDS); Geriatric Anxiety Inventory (GAI); Addenbrooke Cognitive Examination-Revised (ACE-R), which includes the questions of the Mini Mental State Examination (MMSE); Executive Interview (EXIT-25); and the Direct Assessment of Functional Status (DAFS-BR). The protocol for caregivers included the Cornell Scale for Depression in Dementia, Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI) and the Clinical Dementia Rating scale (CDR). Results: In both diagnostic groups DAFS-BR scores correlated significantly with DAD scores (AD: rho¼0.48, p<0.006; bvFTD: rho¼0.56, p<0.001). In the bvFTD group, DAFS-BR and DAD scores were strongly correlated with all cognitive tests but exhibited no associations with neuropsychiatric symptoms. The DAD (indirect assessment) had higher accuracy to distinguish bvFTD from AD (AUC¼0.78, sensitivity¼0.71, specificity¼0.71) than the DAFS-BR, based on direct assessment (AUC¼0.60, sensitivity¼0.55, specificity¼0.65). Conclusions: Results suggest functional impairment in bvFTD, assessed directly or indirectly, is highly associated with cognitive impairment. Direct and indirect assessments of functional deficits in bvFTD seem to contribute to the differential diagnosis between AD and bvFTD, although the DAD exhibited higher accuracy to distinguish the groups. P4-127
RELIGIOUS DOGMATISM IN NEURODEGENERATIVE DISEASE
Nikolas Block1, David Perry1, Virginia Sturm1, Zachary Miller1, Bruce Miller2, 1UCSF Memory and Aging Center, San Francisco, California, United States; 2UCSF Memory and Aging Center, San Francisco, California, United States. Contact e-mail: [email protected]. edu Background: The emergence of religious dogmatism, or hyper-religiosity, in neurodegenerative disease has been previously described but prevalence and attributes by diagnosis are not well characterized. Limbic and paralimbic brain regions, including temporal and orbitofrontal cortex, have been implicated in religious dogmatism and are selectively affected in frontotemporal lobar degenerative disorders. Methods: We examined a large cohort (N¼1607) of patients which included behavioral variant frontotemporal dementia (bvFTD; n¼87), semantic variant primary progressive aphasia (svPPA; n¼57), Alzheimer’s disease (AD; n¼237) and normal controls (NC; n¼587) from the UCSF Memory and Aging Center and identified participants with a clinician-rated feature of religious dogmatism. Rates of mental rigidity were also noted. We hypothesized there would be higher rates ofreligious dogmatism in the bvFTD and svPPA groups as compared to NC and AD, and that dogmatic patients with bvFTD/svPPA would also have higher rates of mental rigidity. Results: We identified a total of 35 participants who were rated by clinicians as exhibiting religious dogmatism: 12 patients with bvFTD, 6patients with svPPA, 2 patients with AD, and 4 NCs. Planned odds ratios were then per-
formed to compare rates of religious dogmatism between diagnostic pairs. There were significantly higher rates of religious dogmatism in bvFTD vs. NC (OR ¼23.32, p<.001), svPPA vs. NC (OR ¼17.14, p<.001), bvFTD vs. AD (OR ¼18.80, p<.001), and svPPA vs. AD (OR ¼13.82, p<.001). Rates of dogmatism in bvFTD vs. svPPA (OR ¼1.36, p ¼.616) and AD vs. NC (OR¼1.24, p ¼.553) were not significantly different. Patients with bvFTD/svPPA who were religiously dogmatic (n¼18) had higher rates of mental rigidity than those patients who were not dogmatic (n¼109), OR ¼9.25, p<.001. Conclusions: Our results find significantly higher rates of religious dogmatism in bvFTD and svPPA as compared to NC and AD, and that religious dogmatism in these patients is associated with higher rates of mental rigidity. This study suggests the selective degeneration of neural systems important for cognitive flexibility in bvFTD and svPPA may be associated with increased dogmatic beliefs in the context of religion.
P4-128
UNDERDIAGNOSIS OF COGNITIVE IMPAIRMENT: RESULTS FROM A POSTMORTEM STUDY
Renata Ferretti-Rebustini1, Ricardo Nitrini2, Lea T. Grinberg3, Renata Leite3, Claudia Suemoto1, Jose Farfel4, Carlos Pasqualucci4, Wilson Jacob-Filho5, 1University of S~ao Paulo Medical School, S~ao Paulo, Brazil; 2University of S~ao Paulo, S~ao Paulo, Brazil; 3University of S~ao Paulo Medical School, S~ao Paulo, Brazil; 4University of S~ao Paulo Medical School, S~ao Paulo, Brazil; 5University of S~ao Paulo, S~ao Paulo, Brazil. Contact e-mail: [email protected] Background: The frequency of underdiagnosis of dementia in Brazil is difficult to estimate. Postmortem studies can contribute to obtain data on this matter. The objective of the present study was to identify the number of cases with cognitive impairment submitted to autopsy that had been diagnosed in life, according to the severity of cognitive impairment and neuropathological diagnosis. Methods: Data was extracted from the Brazilian Brain Bank of the Aging Brain Study Group (BBBABSG) database, in the period of 2005 to 2006. In this period, the subset of people who died in the metropolitan area of S~ao Paulo and were submitted to autopsy in the SPAS were assessed, after informed consent. Cognitive assessment in the BBBABSG was obtained by the CDR application to a reliable informant. Neuropathology followed the BBBABSG criteria. Age, gender and scores of CDR were extracted from the records. Data was analyzed descriptively, as for total frequency and in each gender. Results: Samples was composed by 252 cases, mostly females (50.8%) with mean age of 73.35611.59 yo. Concerning the cognitive impairment, 62.0% of the subjects had no cognitive impairment (CDR 0) and 38.0% were cognitively impaired (CDR 0.5 13.6%; CDR 1 - 7.9%; CDR 2 - 7.0%; CDR 3 - 9.5%. Dementia was diagnosed before death in 23/59 cases (39.0%). Only 8/26 of AD cases were diagnosed before death. (30.8%). Underdiagnosis was also frequent in Mixed Dementia Cases (11/ 31; 64,.5%) and Vascular Dementia (1/18; 94.4%.). Conclusions: Underdiagnosis of dementia is frequent in Brazil.
P4-129
MULTICENTER SUBCORTICAL VASCULAR DEMENTIA ON FDG-PET (VADAPET) STUDY SIGNIFIES MORE POSTERIOR NETWORK HYPOMETABOLISM
Jee-Hyang Jeong1, Sang Soo Cho2, Duk L. Na3, Seol-Heui Han4, 1Ewha Womans University Mokdong Hospital, Seoul, South Korea; 2CAMH, Toronto, Canada; 3Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; 4Konkuk University Medical Center, Seoul, South Korea. Contact e-mail: [email protected] Background: Subcortical vascular dementia (SVD), one of the multi-factorial and multi-pathophysiologic vascular dementias, is a dementia associated with multiple small vessel changes or lacunes in white matter (Binswanger type) or deep nuclei (lacunar type). The aim of the current study is to identify brain regions with glucose hypometabolism in FDGPET using an SPM analysis in patients with SVD recruited from