- Email: [email protected]
STRUCTURED CLINICAL DOCUMENTATION FOR PATIENT CARE AND PRACTICE-BASED RESEARCH IN MCI AND DEMENTIA
P586
Poster Presentations: Sunday, July 24, 2016
College of Medicine, University of South Florida, Tampa, FL, USA. Contact e-mail: [email protected] Background: Sleep Disordered Breathing (SDB) is commonly reported in the elderly, and recent studies in humans describe associations between SDB and Alzheimer’s disease (AD). However, studies are needed that evaluate whether SDB is associated with AD biomarkers. Our objective was to examine whether the presence of SDB is associated with cerebrospinal fluid phosphorylated tau (CSF P-tau), and neuroimaging evidence of hippocampal atrophy and b-amyloid (Ab) deposition in Mild Cognitive Impairment (MCI) subjects from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. Methods: Data used were obtained from the ADNI database (adni.loni.usc.edu). Study participants included a total of 600 MCI subjects who were a subset of the ADNI cohort. SDB was self-reported and participants were labeled SDB+, SDB, and CPAP+ (if they were SDB+, and using “CPAP/BiPAP” treatment). CSF P-tau, hippocampal and Ab-42 volumes were the outcome variables. Multi-level mixed effects linear regression models were used to examine the relationship between SDB and CSF P-tau, hippocampal and Ab-42 volumes. First, we fit a linear regression model for each participant separately at each time point, and second, we regressed unknown time-specific coefficients against time. Our models were adjusted for age, sex, body mass index, APOE e4 status, and history of cardiovascular disease. This approach provided adjusted risk estimates incorporating the effects of time. Results: Relative to SDB- participants, SDB+ participants had an increased risk of greater b-amyloid burden, (mean cortical DVR; adjusted Relative Risk (aRR) ¼ 1.92, 95% confidence interval (CI) 1.16, 4.14, p ¼ 0.002 and precuneus DVR (aRR ¼ 1.51, 95% CI 1.03, 3.18, p ¼ 0.005). SDB was also associated with greater CSF P-Tau burden (aRR ¼ 1.58, 95% CI 1.01, 3.15, p ¼ 0.003) and Hippocampal volume (aRR ¼ 1.88, 95% CI 1.21, 4.15, p ¼ 0.003). There was no difference in risk between CPAP+ and SDB participants (aRR¼1.08, 95% CI 0.71, 2.15, p ¼ 0.003). Conclusions: Among MCI patients in the ADNI cohort, reports of Sleep Disordered Breathing are associated with greater CSF P-Tau, Hippocampal atrophy and b-amyloid burden over time. Further studies with objective measures of SDB are needed to determine whether SDB accelerates Alzheimer disease.
P1-398
STRUCTURED CLINICAL DOCUMENTATION FOR PATIENT CARE AND PRACTICE-BASED RESEARCH IN MCI AND DEMENTIA
Chad J. Yucus, James Castle, Shaun Walters, Lisette Garduno, Roberta Frigerio, Demetrius M. Maraganore, NorthShore University Health System, Evanston, IL, USA. Contact e-mail: [email protected] Background: To improve quality of care of patients with mild cognitive impairment and dementia, we used the electronic medical record to develop structured clinical documentation support (SCDS) tools following quality guidelines for MCI and dementia. The tools also prompted enrollment in practice-based research, including in a DNA biobank beginning in September 2014. Methods: The toolkits assess cognitive, behavioral/psychological, and motor symptoms and also include the Barthel Index, Functional Activities Questionnaire (FAQ), Geriatric Depression Scale (GDS), and Montreal Cognitive Assessment (MoCA). The Functional Assessment Stage Test is used for disease staging. All patients referred to the NorthShore University Health System Department of Neurology for an evaluation of changes in cognition or behavior
are evaluated with our SCDS toolkit at initial visit and annual follow-up visits. At the initial visit, a diagnosis of MCI or dementia electronically prompted the physician to enroll the patient in the DNA biobank. Results: There were 251 patients (103 with MCI and 148 with dementia) enrolled in the biobank. Median age at enrollment was 76 (mean 74.6). Most patients were initially evaluated within 4 years of symptom onset, and a similar age at onset was noted in men and women. Executive symptoms and irritability appeared to occur more frequently in men compared to women but did not reach statistical significance. Overall, there was no significant gender difference in current symptoms at the initial evaluation. However, there was a statistically significant difference between men and women for the place of living (Fisher test, p-value¼0.001), with more women living in assisted living and more men living at home, which may reflect women outliving their spouses. There was no gender difference in MoCA scores or in the distribution of MCI or dementia diagnoses. Pairwise correlations found inverse correlations between age at onset and disease duration and between FAQ and MoCA. The GDS and MoCA were directly correlated. Multidimensional comparisons using principal component analysis revealed that the FAQ accounted for most of the variance between the 6 continuous trait measures (age at onset, disease duration, Barthel Index, FAQ, MoCA, and GDS). Conclusions: Our SCDS toolkit efficiently measures and improves the quality of care in memory disorders and through data capture has the potential to support multicenter practice based research.
P1-399
THE COMBINED UTILITY OF BRIEF COGNITIVE TESTS FOR THE DETECTION OF MILD COGNITIVE IMPAIRMENT: EPIDEMIOLOGY OF DEMENTIA IN SINGAPORE STUDY
Shaik Muhammad Amin1, Saima Hilal1, Jing Xu1, Wei Wu1, Eddie Chong1, Tien Yin Wong2,3, Ching Yu Cheng4, Narayanaswamy Venketasubramanian5, Christopher Chen1, Mohammed Kamran Ikram6, YanHong Dong1, 1National University of Singapore, Singapore, Singapore; 2Duke-NUS Graduate Medical School, Singapore, Singapore; 3Singapore Eye Research Institute, Singapore, Singapore; 4Academic Medicine Research Institute, Duke-NUS Graduate Medical School, Singapore, Singapore; 5Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore; 6University Medical Center Utrecht, Utrecht, Netherlands. Contact e-mail: [email protected] Background: Brief cognitive tests that detect functional decline,
such as the AD8 and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), are less sensitive in detecting Mild Cognitive Impairment (MCI). Combination of these tests may improve overall sensitivity. We examined the combination of the AD8 and 16-item IQCODE to discriminate MCI from No Cognitive Impairment (NCI). Moreover, this discriminant ability was compared by combining the AD8 with a shortened version of the IQCODE (8-items). Methods: Subjects recruited into the Epidemiology of Dementia in Singapore (EDIS) study, completed a neuropsychological battery and the patient-AD8 (P-AD8). Informants completed the IQCODE and informant-AD8 (I-AD8). MCI was defined by the Peterson’s criteria, while NCI was evidenced by no objective cognitive impairment. Area under the receiver operating characteristics (ROC) curve analyses was performed to determine discriminant indices of the AD8 and IQCODE, and their compensatory combinations (i.e., screen positive on either or both tests). Sensitivities and AUC’s were statistically compared.
Poster Presentations: Sunday, July 24, 2016
College of Medicine, University of South Florida, Tampa, FL, USA. Contact e-mail: [email protected] Background: Sleep Disordered Breathing (SDB) is commonly reported in the elderly, and recent studies in humans describe associations between SDB and Alzheimer’s disease (AD). However, studies are needed that evaluate whether SDB is associated with AD biomarkers. Our objective was to examine whether the presence of SDB is associated with cerebrospinal fluid phosphorylated tau (CSF P-tau), and neuroimaging evidence of hippocampal atrophy and b-amyloid (Ab) deposition in Mild Cognitive Impairment (MCI) subjects from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. Methods: Data used were obtained from the ADNI database (adni.loni.usc.edu). Study participants included a total of 600 MCI subjects who were a subset of the ADNI cohort. SDB was self-reported and participants were labeled SDB+, SDB, and CPAP+ (if they were SDB+, and using “CPAP/BiPAP” treatment). CSF P-tau, hippocampal and Ab-42 volumes were the outcome variables. Multi-level mixed effects linear regression models were used to examine the relationship between SDB and CSF P-tau, hippocampal and Ab-42 volumes. First, we fit a linear regression model for each participant separately at each time point, and second, we regressed unknown time-specific coefficients against time. Our models were adjusted for age, sex, body mass index, APOE e4 status, and history of cardiovascular disease. This approach provided adjusted risk estimates incorporating the effects of time. Results: Relative to SDB- participants, SDB+ participants had an increased risk of greater b-amyloid burden, (mean cortical DVR; adjusted Relative Risk (aRR) ¼ 1.92, 95% confidence interval (CI) 1.16, 4.14, p ¼ 0.002 and precuneus DVR (aRR ¼ 1.51, 95% CI 1.03, 3.18, p ¼ 0.005). SDB was also associated with greater CSF P-Tau burden (aRR ¼ 1.58, 95% CI 1.01, 3.15, p ¼ 0.003) and Hippocampal volume (aRR ¼ 1.88, 95% CI 1.21, 4.15, p ¼ 0.003). There was no difference in risk between CPAP+ and SDB participants (aRR¼1.08, 95% CI 0.71, 2.15, p ¼ 0.003). Conclusions: Among MCI patients in the ADNI cohort, reports of Sleep Disordered Breathing are associated with greater CSF P-Tau, Hippocampal atrophy and b-amyloid burden over time. Further studies with objective measures of SDB are needed to determine whether SDB accelerates Alzheimer disease.
P1-398
STRUCTURED CLINICAL DOCUMENTATION FOR PATIENT CARE AND PRACTICE-BASED RESEARCH IN MCI AND DEMENTIA
Chad J. Yucus, James Castle, Shaun Walters, Lisette Garduno, Roberta Frigerio, Demetrius M. Maraganore, NorthShore University Health System, Evanston, IL, USA. Contact e-mail: [email protected] Background: To improve quality of care of patients with mild cognitive impairment and dementia, we used the electronic medical record to develop structured clinical documentation support (SCDS) tools following quality guidelines for MCI and dementia. The tools also prompted enrollment in practice-based research, including in a DNA biobank beginning in September 2014. Methods: The toolkits assess cognitive, behavioral/psychological, and motor symptoms and also include the Barthel Index, Functional Activities Questionnaire (FAQ), Geriatric Depression Scale (GDS), and Montreal Cognitive Assessment (MoCA). The Functional Assessment Stage Test is used for disease staging. All patients referred to the NorthShore University Health System Department of Neurology for an evaluation of changes in cognition or behavior
are evaluated with our SCDS toolkit at initial visit and annual follow-up visits. At the initial visit, a diagnosis of MCI or dementia electronically prompted the physician to enroll the patient in the DNA biobank. Results: There were 251 patients (103 with MCI and 148 with dementia) enrolled in the biobank. Median age at enrollment was 76 (mean 74.6). Most patients were initially evaluated within 4 years of symptom onset, and a similar age at onset was noted in men and women. Executive symptoms and irritability appeared to occur more frequently in men compared to women but did not reach statistical significance. Overall, there was no significant gender difference in current symptoms at the initial evaluation. However, there was a statistically significant difference between men and women for the place of living (Fisher test, p-value¼0.001), with more women living in assisted living and more men living at home, which may reflect women outliving their spouses. There was no gender difference in MoCA scores or in the distribution of MCI or dementia diagnoses. Pairwise correlations found inverse correlations between age at onset and disease duration and between FAQ and MoCA. The GDS and MoCA were directly correlated. Multidimensional comparisons using principal component analysis revealed that the FAQ accounted for most of the variance between the 6 continuous trait measures (age at onset, disease duration, Barthel Index, FAQ, MoCA, and GDS). Conclusions: Our SCDS toolkit efficiently measures and improves the quality of care in memory disorders and through data capture has the potential to support multicenter practice based research.
P1-399
THE COMBINED UTILITY OF BRIEF COGNITIVE TESTS FOR THE DETECTION OF MILD COGNITIVE IMPAIRMENT: EPIDEMIOLOGY OF DEMENTIA IN SINGAPORE STUDY
Shaik Muhammad Amin1, Saima Hilal1, Jing Xu1, Wei Wu1, Eddie Chong1, Tien Yin Wong2,3, Ching Yu Cheng4, Narayanaswamy Venketasubramanian5, Christopher Chen1, Mohammed Kamran Ikram6, YanHong Dong1, 1National University of Singapore, Singapore, Singapore; 2Duke-NUS Graduate Medical School, Singapore, Singapore; 3Singapore Eye Research Institute, Singapore, Singapore; 4Academic Medicine Research Institute, Duke-NUS Graduate Medical School, Singapore, Singapore; 5Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore; 6University Medical Center Utrecht, Utrecht, Netherlands. Contact e-mail: [email protected] Background: Brief cognitive tests that detect functional decline,
such as the AD8 and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), are less sensitive in detecting Mild Cognitive Impairment (MCI). Combination of these tests may improve overall sensitivity. We examined the combination of the AD8 and 16-item IQCODE to discriminate MCI from No Cognitive Impairment (NCI). Moreover, this discriminant ability was compared by combining the AD8 with a shortened version of the IQCODE (8-items). Methods: Subjects recruited into the Epidemiology of Dementia in Singapore (EDIS) study, completed a neuropsychological battery and the patient-AD8 (P-AD8). Informants completed the IQCODE and informant-AD8 (I-AD8). MCI was defined by the Peterson’s criteria, while NCI was evidenced by no objective cognitive impairment. Area under the receiver operating characteristics (ROC) curve analyses was performed to determine discriminant indices of the AD8 and IQCODE, and their compensatory combinations (i.e., screen positive on either or both tests). Sensitivities and AUC’s were statistically compared.