- Email: [email protected]
The association of frailty with cognitive impairment in a cohort of community living older people
P504
Poster Presentations P4
the volumes we used a General Linear Model, adjusted for age and head size. Results: We found significantly lower volumes for the n. accumbens (p <0.001) and thalamus (p <0.02) in all three dementia groups, compared to the non-demented group. Compared to the non-dementia group the volume of the putamen was significantly lower in AD (p ¼0.002) and mixed type dementia (p ¼ 0.003) and the pallidal volume in AD (p ¼ 0.032) and VaD (p ¼ 0.004). Conclusions: In AD, VaD, and mixed type of dementia, atrophy of the basal ganglia and thalamus occurs. Further research is needed to determine whether this atrophy is due to different or shared underlying pathology. P4-251
OBSESSIVE-COMPULSIVE SYMPTOMS IN ALZHEIMER’S DISEASE AND FRONTOTEMPORAL DEMENTIA
Katya Rascovsky, John Neuhaus, Joel H. Kramer, Bruce L. Miller, William W. Seeley, University of California, San Francisco, San Francisco, CA, USA. Contact e-mail: [email protected] Background: Although several studies have reported the presence of obsessive compulsive symptoms (OCS) in neurodegenerative disorders, few studies have compared the frequency and subtypes of OCS in Alzheimer’s Disease (AD), behavioral variant frontotemporal dementia (bvFTD) and Semantic Dementia (SD). Methods: Caregivers of 137 patients (57 AD, 50 bvFTD, 30 SD) completed a behavioral questionnaire derived from the Manchester Informant-Based Behavioral Interview (Snowden, et. al., 2001). The frequency of 29 OC symptoms were rated on an ordinal scale as ‘‘never’’, ‘‘a few times a month’’, ‘‘a few times a week’’, ‘‘daily’’ or ‘‘incessant’’. Results: Ordinal logistic regression showed significant group differences (p <0.05) in the frequency distribution of several obsessive compulsive symptoms. Compared to AD, caregivers of bvFTD and SD patients reported a higher frequency of simple motor and verbal stereotypies, need to do things immediately, rigidity, and strict adherence to a daily routine. BvFTD patients exhibited a higher frequency of complex motor routines (e.g., clapping the same rhythm), pacing fixed routes and echopraxia compared to AD patients. Caregivers of SD patients reported a higher frequency of compulsive gaming (card games), and petty theft compared to AD patients. There were no group differences in the frequency distribution of hypochondriasis, verbal perseverations, repetitive themes, hypergraphia, counting, arranging or aligning objects, over-concern with cleanliness, excessive attention to detail, excessive checking, compulsive word games, unusual toileting routines, superstitious rituals, increased religious practices, new artistic abilities, hoarding, touching or handling objects, echolalia, utilization or reading notices aloud. Conclusions: Frontotemporal dementias exhibit a higher frequency of compulsive symptoms compared to AD. Most of these compulsive behaviors tend to be simple and motoric in nature, and do not appear to include a frank obsessional component. The overlap between bvFTD and SD compulsions suggests that regions targeted in both disorders may modulate compulsivity in the healthy brain. Further studies may help to pinpoint this regulatory anatomical system. P4-252
CSF BIOMARKERS IN POSTERIOR CORTICAL ATROPHY: EVIDENCE FOR A VARIANT OF ALZHEIMER’S DISEASE
Thomas P. Baumann1,2, Hu¨seyin Duyar3, Marc A. Sollberger2,3, Axel Regeniter4, Klaus Schmidtke5, Andreas U. Monsch3, 1Memory Clinic and Dept. of Neurology, University Hospital Basel, Basel, Switzerland; 2 Dept. of Neurology, University Hospital Basel, Switzerland; 3Memory Clinic, Dept. of Geriatrics, University Hospital, Basel, Switzerland; 4Central Laboratory, University Hospital, Basel, Switzerland; 5Ortenau Klinikum, Offenburg, Basel, Germany. Contact e-mail: [email protected] Background: CSF proteins are important diagnostic markers for Alzheimer’s disease (AD). However, CSF protein have not yet been analyzed in patients with posterior cortical atrophy (PCA), which may be a variant of AD. Objective: To measure CSF-concentrations of Abeta 1-42, T-Tauand P-Tau181 in patients with PCA. Methods: CSF samples from 9 cases were analyzed using commercially available ELISA kits. 14 cognitively healthy individuals and 11 matched patients with typical AD served as con-
trols. Results: The CSF-Abeta 1-42 levels in PCA, AD, and controls were 415.56163.2, 463.46185.9, and 840.26214.8, respectively. The concentrations of CSF-Tau in PCA, AD, and controls were 594.06 321.7, 662.26332.9, and 251.96131.8, respectively. The p-Tau levels in PCA, AD, and controls were 75.9631.1, 90.8634.2, and 45.6618.6, respectively. Abeta 1-42, T-Tau- and P-Tau181 CSF levels of PCA and AD patients differed significantly from those in healthy controls (p less or equal to .01). Protein levels of PCA and AD patients were indistinguishable. Conclusions: Elevated CSF-Tau and P-Tau, and lowered Abeta 1-42 levels suggest that biochemically PCA represents a variant of AD. If these findings are replicated by autopsy studies, patients with PCA showing protein abnormalities in CSF that are typical of AD may be eligible for AD trials. P4-253
THE ASSOCIATION OF FRAILTY WITH COGNITIVE IMPAIRMENT IN A COHORT OF COMMUNITY LIVING OLDER PEOPLE
Susan Kurrle, Ian Cameron, University of Sydney, Ryde, Australia. Contact e-mail: [email protected] Background: Two well known assessment methods of frailty are the Cardiovascular Health Study (Fried) criteria (three or more of weight loss, exhaustion, slow walking, limited energy expenditure and limited strength) and the Rockwood Clinical Frailty Scale (8 point ordinal scale from robust to terminally ill). The Fried criteria explicitly do not include cognitive impairment. The aim of this analysis is to examine the association of frailty defined by these criteria, and cognitive impairment. Methods: In the context of a cohort study investigating frailty, at the baseline interview measures of frailty (as defined by the Fried and Rockwood criteria), cognitive impairment (as assessed by the Mini Mental Status Examination (MMSE)), and demographic data were collected by a research nurse. Inclusion criteria were age >70years, MMSE>18 and completion of treatment from a Hospital Aged Care Service. Results: Data from 135 older people, 95 (70.3%) women, mean age 83.8 years were analysed. The baseline prevalence of frailty using the Fried criteria was 75% and the mean MMSE score was 26.1, with 22 (16.3%) people scoring <24. The rank correlation of MMSE with the Fried criteria and the Rockwood Scale were both modest but statistically significant (r -.237, p¼0.006 and r -.388, p<0.001, respectively). Conclusions: In this cohort of elderly community living older people with a high prevalence of frailty, a minority is significantly cognitively impaired but cognitive impairment is associated with the frailty syndrome. The association with the Fried criteria is significant but is somewhat greater with the Rockwood criteria. These observed associations would almost certainly be substantially stronger if people with moderate to severe cognitive impairment were not excluded from the study. Cognitive impairment should be considered in treatment plans developed for frail older people. P4-254
DEMENTIA IN MULTIPLE SCLEROSIS: IS IT ALZHEIMER’S OR A NEW ENTITY?
Ju¨rgen Kohler, Hana Heilmeyer-Kohler, ZENN, Freiburg, Germany. Contact e-mail: [email protected] Background: Multiple Sclerosis (MS) is a chronic autoimmune multifocal inflammatory demyelinating disease with secondary neurodegeneration affecting predominantly females between 20-40 years. The clinical course over years is very variable. Milder cognitive dysfunctions in various conditions are very frequent in acute stage and in the further courses of the disease. Dementia is reported as a rare condition in MS. Rodriguez et al found in 1994 an incidence of 3,7 %. Methods: Over a period of 10 years we have investigated in our outpatient MS center the cognitive state of more than 400 MS patients for dementia according to the DSM IV classification and its correlation to MS. The main neuropsychological instrument was the Minimental Status Examination (MMSE). The Expanded Disability Status Scale (EDSS) of our patients ranged from 0 (no signs, no disability) to 9 (bed ridden, helpless). Results: In our data we classified 3 subtypes of dementia in MS (DMS). In DMS type 1 the cognitive decline is one of the main symptoms and develops early in the disease without marked motor symptoms. The DMS type 2 is associated with an malignant or chronic progressive course of MS itself. Therefore DMS type 2 developed in association with
Poster Presentations P4
the volumes we used a General Linear Model, adjusted for age and head size. Results: We found significantly lower volumes for the n. accumbens (p <0.001) and thalamus (p <0.02) in all three dementia groups, compared to the non-demented group. Compared to the non-dementia group the volume of the putamen was significantly lower in AD (p ¼0.002) and mixed type dementia (p ¼ 0.003) and the pallidal volume in AD (p ¼ 0.032) and VaD (p ¼ 0.004). Conclusions: In AD, VaD, and mixed type of dementia, atrophy of the basal ganglia and thalamus occurs. Further research is needed to determine whether this atrophy is due to different or shared underlying pathology. P4-251
OBSESSIVE-COMPULSIVE SYMPTOMS IN ALZHEIMER’S DISEASE AND FRONTOTEMPORAL DEMENTIA
Katya Rascovsky, John Neuhaus, Joel H. Kramer, Bruce L. Miller, William W. Seeley, University of California, San Francisco, San Francisco, CA, USA. Contact e-mail: [email protected] Background: Although several studies have reported the presence of obsessive compulsive symptoms (OCS) in neurodegenerative disorders, few studies have compared the frequency and subtypes of OCS in Alzheimer’s Disease (AD), behavioral variant frontotemporal dementia (bvFTD) and Semantic Dementia (SD). Methods: Caregivers of 137 patients (57 AD, 50 bvFTD, 30 SD) completed a behavioral questionnaire derived from the Manchester Informant-Based Behavioral Interview (Snowden, et. al., 2001). The frequency of 29 OC symptoms were rated on an ordinal scale as ‘‘never’’, ‘‘a few times a month’’, ‘‘a few times a week’’, ‘‘daily’’ or ‘‘incessant’’. Results: Ordinal logistic regression showed significant group differences (p <0.05) in the frequency distribution of several obsessive compulsive symptoms. Compared to AD, caregivers of bvFTD and SD patients reported a higher frequency of simple motor and verbal stereotypies, need to do things immediately, rigidity, and strict adherence to a daily routine. BvFTD patients exhibited a higher frequency of complex motor routines (e.g., clapping the same rhythm), pacing fixed routes and echopraxia compared to AD patients. Caregivers of SD patients reported a higher frequency of compulsive gaming (card games), and petty theft compared to AD patients. There were no group differences in the frequency distribution of hypochondriasis, verbal perseverations, repetitive themes, hypergraphia, counting, arranging or aligning objects, over-concern with cleanliness, excessive attention to detail, excessive checking, compulsive word games, unusual toileting routines, superstitious rituals, increased religious practices, new artistic abilities, hoarding, touching or handling objects, echolalia, utilization or reading notices aloud. Conclusions: Frontotemporal dementias exhibit a higher frequency of compulsive symptoms compared to AD. Most of these compulsive behaviors tend to be simple and motoric in nature, and do not appear to include a frank obsessional component. The overlap between bvFTD and SD compulsions suggests that regions targeted in both disorders may modulate compulsivity in the healthy brain. Further studies may help to pinpoint this regulatory anatomical system. P4-252
CSF BIOMARKERS IN POSTERIOR CORTICAL ATROPHY: EVIDENCE FOR A VARIANT OF ALZHEIMER’S DISEASE
Thomas P. Baumann1,2, Hu¨seyin Duyar3, Marc A. Sollberger2,3, Axel Regeniter4, Klaus Schmidtke5, Andreas U. Monsch3, 1Memory Clinic and Dept. of Neurology, University Hospital Basel, Basel, Switzerland; 2 Dept. of Neurology, University Hospital Basel, Switzerland; 3Memory Clinic, Dept. of Geriatrics, University Hospital, Basel, Switzerland; 4Central Laboratory, University Hospital, Basel, Switzerland; 5Ortenau Klinikum, Offenburg, Basel, Germany. Contact e-mail: [email protected] Background: CSF proteins are important diagnostic markers for Alzheimer’s disease (AD). However, CSF protein have not yet been analyzed in patients with posterior cortical atrophy (PCA), which may be a variant of AD. Objective: To measure CSF-concentrations of Abeta 1-42, T-Tauand P-Tau181 in patients with PCA. Methods: CSF samples from 9 cases were analyzed using commercially available ELISA kits. 14 cognitively healthy individuals and 11 matched patients with typical AD served as con-
trols. Results: The CSF-Abeta 1-42 levels in PCA, AD, and controls were 415.56163.2, 463.46185.9, and 840.26214.8, respectively. The concentrations of CSF-Tau in PCA, AD, and controls were 594.06 321.7, 662.26332.9, and 251.96131.8, respectively. The p-Tau levels in PCA, AD, and controls were 75.9631.1, 90.8634.2, and 45.6618.6, respectively. Abeta 1-42, T-Tau- and P-Tau181 CSF levels of PCA and AD patients differed significantly from those in healthy controls (p less or equal to .01). Protein levels of PCA and AD patients were indistinguishable. Conclusions: Elevated CSF-Tau and P-Tau, and lowered Abeta 1-42 levels suggest that biochemically PCA represents a variant of AD. If these findings are replicated by autopsy studies, patients with PCA showing protein abnormalities in CSF that are typical of AD may be eligible for AD trials. P4-253
THE ASSOCIATION OF FRAILTY WITH COGNITIVE IMPAIRMENT IN A COHORT OF COMMUNITY LIVING OLDER PEOPLE
Susan Kurrle, Ian Cameron, University of Sydney, Ryde, Australia. Contact e-mail: [email protected] Background: Two well known assessment methods of frailty are the Cardiovascular Health Study (Fried) criteria (three or more of weight loss, exhaustion, slow walking, limited energy expenditure and limited strength) and the Rockwood Clinical Frailty Scale (8 point ordinal scale from robust to terminally ill). The Fried criteria explicitly do not include cognitive impairment. The aim of this analysis is to examine the association of frailty defined by these criteria, and cognitive impairment. Methods: In the context of a cohort study investigating frailty, at the baseline interview measures of frailty (as defined by the Fried and Rockwood criteria), cognitive impairment (as assessed by the Mini Mental Status Examination (MMSE)), and demographic data were collected by a research nurse. Inclusion criteria were age >70years, MMSE>18 and completion of treatment from a Hospital Aged Care Service. Results: Data from 135 older people, 95 (70.3%) women, mean age 83.8 years were analysed. The baseline prevalence of frailty using the Fried criteria was 75% and the mean MMSE score was 26.1, with 22 (16.3%) people scoring <24. The rank correlation of MMSE with the Fried criteria and the Rockwood Scale were both modest but statistically significant (r -.237, p¼0.006 and r -.388, p<0.001, respectively). Conclusions: In this cohort of elderly community living older people with a high prevalence of frailty, a minority is significantly cognitively impaired but cognitive impairment is associated with the frailty syndrome. The association with the Fried criteria is significant but is somewhat greater with the Rockwood criteria. These observed associations would almost certainly be substantially stronger if people with moderate to severe cognitive impairment were not excluded from the study. Cognitive impairment should be considered in treatment plans developed for frail older people. P4-254
DEMENTIA IN MULTIPLE SCLEROSIS: IS IT ALZHEIMER’S OR A NEW ENTITY?
Ju¨rgen Kohler, Hana Heilmeyer-Kohler, ZENN, Freiburg, Germany. Contact e-mail: [email protected] Background: Multiple Sclerosis (MS) is a chronic autoimmune multifocal inflammatory demyelinating disease with secondary neurodegeneration affecting predominantly females between 20-40 years. The clinical course over years is very variable. Milder cognitive dysfunctions in various conditions are very frequent in acute stage and in the further courses of the disease. Dementia is reported as a rare condition in MS. Rodriguez et al found in 1994 an incidence of 3,7 %. Methods: Over a period of 10 years we have investigated in our outpatient MS center the cognitive state of more than 400 MS patients for dementia according to the DSM IV classification and its correlation to MS. The main neuropsychological instrument was the Minimental Status Examination (MMSE). The Expanded Disability Status Scale (EDSS) of our patients ranged from 0 (no signs, no disability) to 9 (bed ridden, helpless). Results: In our data we classified 3 subtypes of dementia in MS (DMS). In DMS type 1 the cognitive decline is one of the main symptoms and develops early in the disease without marked motor symptoms. The DMS type 2 is associated with an malignant or chronic progressive course of MS itself. Therefore DMS type 2 developed in association with