- Email: [email protected]
Risk of nursing home placement in dementia with Lewy bodies and Alzheimer's dementia
Oral O1-02: Diagnosis and Disease Progression: Clinical 1 AD pathology in healthy elderly(CN) and mild cognitive impairment(MCI).We tested the hypothesis that there would be an association between rates of regional brain atrophy with baseline AD biomarkers p-tau and Ab1-42 concentrations. Methods: We examined the rate of change in tissue volume across brain in age-matched 70 CN(mean ADAS-cog 6.09), 119 MCI(mean ADAS-cog 12.11),and 46 AD patients(mean ADAS-cog 19.30).Structural brain MRI scans at three time points(baseline,6 and 12 months) were acquired at multiple ADNI sites using 1.5TMRI scanners.Using FreeSurfer4.1,a total of 94 cortical and sub-cortical volumes were automatically measured at baseline scans and longitudinal processing was utilized to estimated the corresponding volumes at 6 and 12 months scans.In each diagnostic group,linear mixed effect models followed by pair-wise maximum likelihood test were performed to determine if baseline biomarker levels predict regional absolute volumes as well as volume change over time after accounting for variations in ADAS-cog scores at scan times. Results: Lower Ab1-42 levels were associated with(i)higher annual atrophy rates of hippocampus in AD(p < 0.01),(ii)increased rates of ventricular enlargement and medial temporal lobe atrophy in CN,and(iii)increase rates of atrophy prominently in cortical regions,stretching from the medial to inferior temporal and frontal cortices in MCI.In contrast to Ab1-42,p-tau levels were not significantly associated with any brain volume changes in AD.In CN and MCI,however,the association between higher levels of p-tau and increased rates of brain atrophy largely mirrored the pattern seen for Ab1-42,though associations with p-tau involved fewer regions in MCI.Neither absolute volume measure nor decline rate in ADAS-cog correlated with baseline biomarker concentrations significantly,in any of the diagnostic group. Conclusions: The finding of faster progression of brain atrophy in presence of lower baseline Ab1-42 and higher p-tau levels supports the hypothesis that Ab1-42 and tau are measures of early AD pathology.Therefore,we propose that Ab1-42 and p-tau could serve as ‘‘predictors’’ and rates of brain atrophy(and ventricular expansion) could serve as ‘‘outcome measures’’ in AD prevention trials of healthy elderly and MCI, greatly improving the power of such trials,compared to clinical/cognitive measures.
SUNDAY, JULY 12, 2009 ORAL O1-02 DIAGNOSIS AND DISEASE PROGRESSION: CLINICAL 1 O1-02-01
RISK OF NURSING HOME PLACEMENT IN DEMENTIA WITH LEWY BODIES AND ALZHEIMER’S DEMENTIA
Arvid Rongve1, Ragnhild Skogseth2, Dag Aarsland3, 1Helse-Fonna HF, Haugesund, Norway; 2University of Bergen, Bergen, Norway; 3Stavanger University Hospital, Stavanger, Norway. Contact e-mail: arvid.rongve@ helse-fonna.no
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Background: Few studies of the clinical course of patients with Dementia with Lewy Bodies (DLB) have been reported and conflicting findings have been found. The aim of this project was to study the risk of nursing home placement in a cohort with mild DLB and mild Alzheimer’s dementia. (AD) Methods: All home-dwelling patients with a first time diagnosis of mild dementia at out-patient clinics in geriatric medicine, neurology and old age psychiatry in Western Norway were invited to participate. Selection criterion was a Mini Mental State Examination (MMSE) score 20. Standard diagnostic criteria were applied after a comprehensive diagnostic program including neuropsychological tests, standardized assessments of hallucinations, parkinsonism, sleep disorders and fluctuating cognition as well as imaging and laboratory tests. DLB was diagnosed using the revised consensus criteria. Patients were re-assessed after 12 months, and patients who had been transferred to permanently residing in nursing homes or alternating between home and nursing home were registered. Results: Of a total of 196 patients included, 180 (91.8%) completed follow-up (7 had died, 5 refused, and 4 had missing data). Of these, 121 had AD and 35 had DLB. At baseline these groups did not differ regarding education or MMSE score, but the DLB patients were older had significantly more impaired ADL function, higher proportion with males and a longer duration of disease prior to diagnosis. Twenty-five patients (13.9%) had been institutionalized during the study-period, 12 (9.9%) with AD and 9 (25.7%) with DLB. This difference was statistically significant (P ¼ 0.024 Fisher’s exact test). Results from a multivariate survival analysis using Cox regression will be presented at the meeting. Conclusions: More than one quarter of patients with mild DLB had been admitted to a nursing home within one year after diagnosis, compared with less than 10% of those with mild AD. Patients with DLB constitute a highly vulnerable group, with a rapid functional decline and high health-related costs. O1-02-02
PREDICTION OF NEUROPATHOLOGY IN PRIMARY PROGRESSIVE LANGUAGE AND SPEECH DISORDERS
Vincent Deramecourt1,2, Florence Lebert1,2, Luc Buee3, Claude Alain Maurage4,3, Florence Pasquier1,2, 1Memory Clinic, University Hospital, Lille, France; 2EA2691, Lille II University, Lille, France; 3INSERM U837, JPARC, Lille, France; 4Neuropathology Department, University Hospital, Lille, France. Contact e-mail: [email protected] Background: Frontotemporal lobar degeneration (FTLD) encompasses heterogeneous clinicopathological entities. The ante mortem prediction of the underlying pathological lesions is reputed to be difficult or even impossible, whatever the clinical variant. This study aimed to characterize the correlations between the different clinical variants of primary progressive language and speech disorders and the pathological diagnosis. Methods: Pathological diagnosis was available for 17 patients prospectively followed-up in the Lille (France) Memory Clinic between 1993 and 2008. These cases were diagnosed with progressive anarthria (n ¼ 5), agrammatic progressive aphasia (n ¼ 6), logopenic progressive aphasia (n ¼ 1), progressive jargon aphasia (n ¼ 2), typical semantic dementia (n ¼ 1) and atypical semantic dementia (n ¼ 2). Results: All cases of progressive anarthria had a tauopathie at post mortem evaluation: PSP (n ¼ 2), Pick disease (n ¼ 2) and corticobasal degeneration (n ¼ 1). All cases of agrammatic primary progressive aphasia had ubiquitine and TDP-43 positive FTLD (FTLD-U). The case of logopenic progressive aphasia and the cases of progressive jargon aphasia had Alzheimer’s disease (AD). The typical case of semantic dementia had FTLD-U. The cases of atypical semantic dementia had tauopathies: argyrophilic grains disease (AGD) and corticobasal degeneration. Conclusions: The different anatomical distribution of the pathological lesions could explain these good correlations: opercular and subcortical regions in tauopathies with progressive anarthria, left frontotemporal cortex in FTLD-U with agrammatic progressive aphasia, bilateral lateral and anterior temporal cortex in FTLD-U or AGD with semantic dementia, left parietotemporal cortex in AD with logopenic progressive aphasia or jargon aphasia.
SUNDAY, JULY 12, 2009 ORAL O1-02 DIAGNOSIS AND DISEASE PROGRESSION: CLINICAL 1 O1-02-01
RISK OF NURSING HOME PLACEMENT IN DEMENTIA WITH LEWY BODIES AND ALZHEIMER’S DEMENTIA
Arvid Rongve1, Ragnhild Skogseth2, Dag Aarsland3, 1Helse-Fonna HF, Haugesund, Norway; 2University of Bergen, Bergen, Norway; 3Stavanger University Hospital, Stavanger, Norway. Contact e-mail: arvid.rongve@ helse-fonna.no
P79
Background: Few studies of the clinical course of patients with Dementia with Lewy Bodies (DLB) have been reported and conflicting findings have been found. The aim of this project was to study the risk of nursing home placement in a cohort with mild DLB and mild Alzheimer’s dementia. (AD) Methods: All home-dwelling patients with a first time diagnosis of mild dementia at out-patient clinics in geriatric medicine, neurology and old age psychiatry in Western Norway were invited to participate. Selection criterion was a Mini Mental State Examination (MMSE) score 20. Standard diagnostic criteria were applied after a comprehensive diagnostic program including neuropsychological tests, standardized assessments of hallucinations, parkinsonism, sleep disorders and fluctuating cognition as well as imaging and laboratory tests. DLB was diagnosed using the revised consensus criteria. Patients were re-assessed after 12 months, and patients who had been transferred to permanently residing in nursing homes or alternating between home and nursing home were registered. Results: Of a total of 196 patients included, 180 (91.8%) completed follow-up (7 had died, 5 refused, and 4 had missing data). Of these, 121 had AD and 35 had DLB. At baseline these groups did not differ regarding education or MMSE score, but the DLB patients were older had significantly more impaired ADL function, higher proportion with males and a longer duration of disease prior to diagnosis. Twenty-five patients (13.9%) had been institutionalized during the study-period, 12 (9.9%) with AD and 9 (25.7%) with DLB. This difference was statistically significant (P ¼ 0.024 Fisher’s exact test). Results from a multivariate survival analysis using Cox regression will be presented at the meeting. Conclusions: More than one quarter of patients with mild DLB had been admitted to a nursing home within one year after diagnosis, compared with less than 10% of those with mild AD. Patients with DLB constitute a highly vulnerable group, with a rapid functional decline and high health-related costs. O1-02-02
PREDICTION OF NEUROPATHOLOGY IN PRIMARY PROGRESSIVE LANGUAGE AND SPEECH DISORDERS
Vincent Deramecourt1,2, Florence Lebert1,2, Luc Buee3, Claude Alain Maurage4,3, Florence Pasquier1,2, 1Memory Clinic, University Hospital, Lille, France; 2EA2691, Lille II University, Lille, France; 3INSERM U837, JPARC, Lille, France; 4Neuropathology Department, University Hospital, Lille, France. Contact e-mail: [email protected] Background: Frontotemporal lobar degeneration (FTLD) encompasses heterogeneous clinicopathological entities. The ante mortem prediction of the underlying pathological lesions is reputed to be difficult or even impossible, whatever the clinical variant. This study aimed to characterize the correlations between the different clinical variants of primary progressive language and speech disorders and the pathological diagnosis. Methods: Pathological diagnosis was available for 17 patients prospectively followed-up in the Lille (France) Memory Clinic between 1993 and 2008. These cases were diagnosed with progressive anarthria (n ¼ 5), agrammatic progressive aphasia (n ¼ 6), logopenic progressive aphasia (n ¼ 1), progressive jargon aphasia (n ¼ 2), typical semantic dementia (n ¼ 1) and atypical semantic dementia (n ¼ 2). Results: All cases of progressive anarthria had a tauopathie at post mortem evaluation: PSP (n ¼ 2), Pick disease (n ¼ 2) and corticobasal degeneration (n ¼ 1). All cases of agrammatic primary progressive aphasia had ubiquitine and TDP-43 positive FTLD (FTLD-U). The case of logopenic progressive aphasia and the cases of progressive jargon aphasia had Alzheimer’s disease (AD). The typical case of semantic dementia had FTLD-U. The cases of atypical semantic dementia had tauopathies: argyrophilic grains disease (AGD) and corticobasal degeneration. Conclusions: The different anatomical distribution of the pathological lesions could explain these good correlations: opercular and subcortical regions in tauopathies with progressive anarthria, left frontotemporal cortex in FTLD-U with agrammatic progressive aphasia, bilateral lateral and anterior temporal cortex in FTLD-U or AGD with semantic dementia, left parietotemporal cortex in AD with logopenic progressive aphasia or jargon aphasia.