- Email: [email protected]
Sleep disturbance predicts incident dementia and mortality
Oral Sessions: O3-10: Diagnosis and Prognosis: Non-amnestic and Other Clinical Symptoms
P541
Table 2
The results of language and neuropsychological tests of lvPPA patients (Continued ) Case No. Recognition (/9) Calculation (/5) Digit span, forward backward Verbal fluency Animals/min. D words/min. Modified TMT Time (sec) Correct line (/14) GDS (/30)
1
2 9 3
–
3
c 5 –
4 8 3
9 3
–
5
6
9
10
11
12
13
14
15
16
17
Mean (SD)
3
3
8 7
12 10
12 9
2 11
7 7
5 2
14 10
6 1
10 7
6 3
6 5
9 7
15 16
13 9
10.19 (4.04) 8.69 (4.32)
73 14 2
43 14 7
66 14 3
62 14 8
120 6 8
120 2 4
92 14 2
58 14 4
59 14 2
120 1 15
120 8 –
120 3 15
57 14 3
90 13 3
84.06 (32.66) 11.13 (4.35) 6.60 (4.55)
4
5
– 3
13 7
16 18
14 12
120 11 6
120 10 12
25 14 9
–
7 4
8
8 2 3 4
2
7 5
7
–
8 3 4 4
7 4 4 3
9 4 5 3
7 4 4 3
6 3 4 3
5 4 3 3
7 3 4 4
8 4 3 3
9 5 5 3
7 3 5 3
7.60 (1.18) 3.63 (0.89) 4.00 (0.82) 3.31 (0.70)
Apraxia of speech (/7)), dysarthria (/7), and BNT (Boston Naming Test) with semantic cue: 0 in all patients. WAB: Western Aphasia Battery, BNT, phon. cues: Boston Naming Test, phonemic cues, PPVT-R: Peabody Picture Vocabulary Test-Revised, PPT: Pyramids and Palm Trees test, AWR: auditory word recognition, Seq. command: sequential command, CYCLE: Curtiss-Yamada Comprehensive Language Evaluation, UCSF syn. compr.: UCSF syntax comprehension test. We administered PALPA (Psycholinguistic Assessments of Language Processing in Aphasia – marked with *) and Arizona test for reading and spelling. MMSE: Mini-Mental State Examination, VOSP: Visual Object and Spatial Perception, CVLT-SF: California Verbal Learning Test-San Francisco, Modified Rey figure & CVLT-SF, delayed recall: 10-min delayed recall, Y: yes, N: no, Modified TMT: Modified Trail Making Test, GDS: Geriatric depression scale, a, b, and c: CVLT-2 (On a 16 item word-list learning task, this patient demonstrated an above average learning curve (8, 10, 12, 14, 15), delayed memory in the above average range (15/16), and recognition memory for verbal information was intact (16/16), “–” denotes the test was not administered. The Mean (SD) was calculated based on the results of PiB PET (+) patients (excluded case 9).
Table 3 Severity of behavioral problems of lvPPA with PiB PET (+) patients at their first evaluations
Delusions Hallucinations Agitation Depression Anxiety Elation Apathy Disinhibition Irritability Motor disturbance Nighttime behaviors Appetite and eating
Mild
Moderate
Severe
0 0 4 5 4 0 8 0 3 3 2 2
0 0 4 1 4 1 2 0 4 0 0 2
0 0 0 0 0 0 0 0 1 0 0 0
(Case 9: excluded on this table, but had moderate degree of anxiety and mild apathy) the University of California, San Francisco (UCSF) Memory and Aging Center database, which comprised of a consecutive series of patients who met PPA criteria between Jan. 2004 and Dec. 2012. Nineteen lvPPA patients underwent PiB-PET imaging. Finally, we recruited 17 lvPPA patients with MMSE scores of 15 or more on their first language evaluation. Medical charts, speech and language evaluations, and neuropsychological data were retrospectively reviewed. Results: The 17 included cases consisted of 8 women and 9 men. Sixteen out of 17 lvPPA patients were PiB-PET (+). The mean age of PiB-PET (+) lvPPA patients at their first evaluation was 64.31 years of age (6 8.3), disease duration was 4.38 years (6 1.96), and the mean age at the reported onset of symptoms was about 60 years of age. The one PiBPET (-) lvPPA patient was a 69 year old woman with a disease duration of 2.5 years. The frequency of APOE-ε4 haplotype in this group was 31%, and there were 3 cases (18.75%) of developmental dyslexia. Conclusions: Only one case in our study was PiB-PET (-). Although this patient did not have family of PPA or FTD, we checked for GRN mutation, but the result was negative. There is another etiology for lvPPA patients but AD pathology and GRN mutation. We expect that these observations will contribute to a greater understanding and subsequent diagnosis of lvPPA.
O3-10-04
SLEEP DISTURBANCE PREDICTS INCIDENT DEMENTIA AND MORTALITY
Roxanne Sterniczuk, Olga Theou, Benjamin Rusak, Kenneth Rockwood, Dalhousie University, Halifax, Nova Scotia, Canada. Contact e-mail: [email protected] Background: Disruptions to the sleep-wake cycle are commonly reported by those with Alzheimer’s disease (AD). Our previous work has shown that disrupted sleep, as measured by a sleep disturbance index (SDI) in otherwise healthy individuals, may predict incident dementia, but not mortality, at a w2 year follow-up. We examined whether similar sleep disturbance is characteristic of preclinical dementia over a longer interval preceding a report of AD or dementia. Methods: Secondary analyses were conducted on data from the Survey of Health, Aging, and Retirement in Europe, including 30,038 adults residing in 12 European countries. At baseline, only those aged 50+ who did not report a diagnosis of AD or dementia, and were not cognitively impaired on more than one of five domains, were selected for the binary logistic regression analyses; 14,410 participants met these criteria. The SDI consisted of four sleep related factors. Outcome measures were (1) a self- or informant report of AD or dementia and (2) mortality. Results: After controlling for age, sex, education, body mass index, and traditional risk factors for AD, our SDI significantly predicted incident dementia (n ¼ 53; OR ¼ 1.11, 95% CI ¼ 1.02-1.21) and mortality (n ¼ 302; OR ¼ 1.08, 95% CI ¼ 1.03-1.12), after w4 years. Individually, reports of ‘sleeping problems during the past 6 months’, ‘recent trouble sleeping or change in pattern’ and ‘restless sleep’ were significant predictors of dementia. These predictors, along with ‘taking sleeping medication for sleeping problems’, were significantly predictive of mortality. Conclusions: Consistent with the first follow-up findings, otherwise healthy individuals who score higher on the SDI, were a greater risk of incident dementia and of early mortality, in contrast to our findings at w2 year follow-up, at which time the SDI predicted dementia but did not predict increased mortality risk. Symptoms of sleep disturbance appear to be early markers of emerging dementia symptoms and increased risk of subsequent mortality. These results suggest that understanding the mechanisms giving rise to reports of disturbed sleep in otherwise generally healthy older people may provide opportunities for early interventions to reduce the risk of later emergency of dementia and early mortality.
P541
Table 2
The results of language and neuropsychological tests of lvPPA patients (Continued ) Case No. Recognition (/9) Calculation (/5) Digit span, forward backward Verbal fluency Animals/min. D words/min. Modified TMT Time (sec) Correct line (/14) GDS (/30)
1
2 9 3
–
3
c 5 –
4 8 3
9 3
–
5
6
9
10
11
12
13
14
15
16
17
Mean (SD)
3
3
8 7
12 10
12 9
2 11
7 7
5 2
14 10
6 1
10 7
6 3
6 5
9 7
15 16
13 9
10.19 (4.04) 8.69 (4.32)
73 14 2
43 14 7
66 14 3
62 14 8
120 6 8
120 2 4
92 14 2
58 14 4
59 14 2
120 1 15
120 8 –
120 3 15
57 14 3
90 13 3
84.06 (32.66) 11.13 (4.35) 6.60 (4.55)
4
5
– 3
13 7
16 18
14 12
120 11 6
120 10 12
25 14 9
–
7 4
8
8 2 3 4
2
7 5
7
–
8 3 4 4
7 4 4 3
9 4 5 3
7 4 4 3
6 3 4 3
5 4 3 3
7 3 4 4
8 4 3 3
9 5 5 3
7 3 5 3
7.60 (1.18) 3.63 (0.89) 4.00 (0.82) 3.31 (0.70)
Apraxia of speech (/7)), dysarthria (/7), and BNT (Boston Naming Test) with semantic cue: 0 in all patients. WAB: Western Aphasia Battery, BNT, phon. cues: Boston Naming Test, phonemic cues, PPVT-R: Peabody Picture Vocabulary Test-Revised, PPT: Pyramids and Palm Trees test, AWR: auditory word recognition, Seq. command: sequential command, CYCLE: Curtiss-Yamada Comprehensive Language Evaluation, UCSF syn. compr.: UCSF syntax comprehension test. We administered PALPA (Psycholinguistic Assessments of Language Processing in Aphasia – marked with *) and Arizona test for reading and spelling. MMSE: Mini-Mental State Examination, VOSP: Visual Object and Spatial Perception, CVLT-SF: California Verbal Learning Test-San Francisco, Modified Rey figure & CVLT-SF, delayed recall: 10-min delayed recall, Y: yes, N: no, Modified TMT: Modified Trail Making Test, GDS: Geriatric depression scale, a, b, and c: CVLT-2 (On a 16 item word-list learning task, this patient demonstrated an above average learning curve (8, 10, 12, 14, 15), delayed memory in the above average range (15/16), and recognition memory for verbal information was intact (16/16), “–” denotes the test was not administered. The Mean (SD) was calculated based on the results of PiB PET (+) patients (excluded case 9).
Table 3 Severity of behavioral problems of lvPPA with PiB PET (+) patients at their first evaluations
Delusions Hallucinations Agitation Depression Anxiety Elation Apathy Disinhibition Irritability Motor disturbance Nighttime behaviors Appetite and eating
Mild
Moderate
Severe
0 0 4 5 4 0 8 0 3 3 2 2
0 0 4 1 4 1 2 0 4 0 0 2
0 0 0 0 0 0 0 0 1 0 0 0
(Case 9: excluded on this table, but had moderate degree of anxiety and mild apathy) the University of California, San Francisco (UCSF) Memory and Aging Center database, which comprised of a consecutive series of patients who met PPA criteria between Jan. 2004 and Dec. 2012. Nineteen lvPPA patients underwent PiB-PET imaging. Finally, we recruited 17 lvPPA patients with MMSE scores of 15 or more on their first language evaluation. Medical charts, speech and language evaluations, and neuropsychological data were retrospectively reviewed. Results: The 17 included cases consisted of 8 women and 9 men. Sixteen out of 17 lvPPA patients were PiB-PET (+). The mean age of PiB-PET (+) lvPPA patients at their first evaluation was 64.31 years of age (6 8.3), disease duration was 4.38 years (6 1.96), and the mean age at the reported onset of symptoms was about 60 years of age. The one PiBPET (-) lvPPA patient was a 69 year old woman with a disease duration of 2.5 years. The frequency of APOE-ε4 haplotype in this group was 31%, and there were 3 cases (18.75%) of developmental dyslexia. Conclusions: Only one case in our study was PiB-PET (-). Although this patient did not have family of PPA or FTD, we checked for GRN mutation, but the result was negative. There is another etiology for lvPPA patients but AD pathology and GRN mutation. We expect that these observations will contribute to a greater understanding and subsequent diagnosis of lvPPA.
O3-10-04
SLEEP DISTURBANCE PREDICTS INCIDENT DEMENTIA AND MORTALITY
Roxanne Sterniczuk, Olga Theou, Benjamin Rusak, Kenneth Rockwood, Dalhousie University, Halifax, Nova Scotia, Canada. Contact e-mail: [email protected] Background: Disruptions to the sleep-wake cycle are commonly reported by those with Alzheimer’s disease (AD). Our previous work has shown that disrupted sleep, as measured by a sleep disturbance index (SDI) in otherwise healthy individuals, may predict incident dementia, but not mortality, at a w2 year follow-up. We examined whether similar sleep disturbance is characteristic of preclinical dementia over a longer interval preceding a report of AD or dementia. Methods: Secondary analyses were conducted on data from the Survey of Health, Aging, and Retirement in Europe, including 30,038 adults residing in 12 European countries. At baseline, only those aged 50+ who did not report a diagnosis of AD or dementia, and were not cognitively impaired on more than one of five domains, were selected for the binary logistic regression analyses; 14,410 participants met these criteria. The SDI consisted of four sleep related factors. Outcome measures were (1) a self- or informant report of AD or dementia and (2) mortality. Results: After controlling for age, sex, education, body mass index, and traditional risk factors for AD, our SDI significantly predicted incident dementia (n ¼ 53; OR ¼ 1.11, 95% CI ¼ 1.02-1.21) and mortality (n ¼ 302; OR ¼ 1.08, 95% CI ¼ 1.03-1.12), after w4 years. Individually, reports of ‘sleeping problems during the past 6 months’, ‘recent trouble sleeping or change in pattern’ and ‘restless sleep’ were significant predictors of dementia. These predictors, along with ‘taking sleeping medication for sleeping problems’, were significantly predictive of mortality. Conclusions: Consistent with the first follow-up findings, otherwise healthy individuals who score higher on the SDI, were a greater risk of incident dementia and of early mortality, in contrast to our findings at w2 year follow-up, at which time the SDI predicted dementia but did not predict increased mortality risk. Symptoms of sleep disturbance appear to be early markers of emerging dementia symptoms and increased risk of subsequent mortality. These results suggest that understanding the mechanisms giving rise to reports of disturbed sleep in otherwise generally healthy older people may provide opportunities for early interventions to reduce the risk of later emergency of dementia and early mortality.