- Email: [email protected]
THE COMBINED UTILITY OF BRIEF COGNITIVE TESTS FOR THE DETECTION OF MILD COGNITIVE IMPAIRMENT: EPIDEMIOLOGY OF DEMENTIA IN SINGAPORE STUDY
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 Results: Of 834 patients included in the analyses, n¼288 were NCI and n¼546 were MCI. ROC curve analysis revealed 8 items of the IQCODE most sensitive in discriminating MCI. Low sensitivity was observed in the discriminant indices of the P-AD8 (Area under the curve (AUC): 0.60, sensitivity: 54.4%, specificity: 65.1%, cutoff: 1), I-AD8 (AUC: 0.58, sensitivity: 45.6%, specificity: 70.8%, cut-off: 1), 16-item IQCODE (AUC: 0.56, sensitivity: 57.5%, specificity: 54.5%, cut-off: 3.03) and the 8-item IQCODE (AUC: 0.58, sensitivity: 55.5%, specificity: 56.9%, cut-off: 3.06). However, the sensitivities of the P-AD8, 16-item and 8item IQCODE were higher than the I-AD8 (p<0.001). Therefore, combination of the P-AD8 and 16-item IQCODE (AUC: 0.60, sensitivity: 79.1%, specificity: 38.8%) or 8-item IQCODE (AUC: 0.59, sensitivity: 78.1%, specificity: 39.2%) demonstrated increase in overall sensitivity. Though there were significant differences between the sensitivities of the two combinations (p¼0.030), comparison of AUC’s showed no differences (p¼0.899). Conclusions: The compensatory combination of the P-AD8 with the 8-item IQCODE improves overall sensitivity for detecting MCI. The absence of significant functional decline in the MCI criteria accounts for the poor AUC of each test. This indicates that tests designed to detect functional decline are not suitable to detect MCI.
P1-400
THE COMPARISONS OF ETIOLOGIES, CLINICAL FEATURES FOCUSING ON BEHAVIOR PROBLEM AND CAREGIVER BURDENS BETWEEN EARLY ONSET DEMENTIA (EOD) AND LATE ONSET DEMENTIA (LOD)
Jay Cheol Kwon1, Byunggun Kim2, Kyungsoo Lee3, Nack-cheon Choi4, Yohan Jung1, 1Changwon Fatima Hospital, Changwon, The Republic of Korea; 2Eulji University Hospital, Seoul, The Republic of Korea; 3Samsung Changwon Hispital, Changwon, The Republic of Korea; 4Gyeongsang National University Hospital, Chinju, The Republic of Korea. Contact e-mail: [email protected] Background: Although EOD and LOD have common etiologic dis-
ease, they may show the different clinical features including cognition and abnormal behavior. The burden of their caregivers could be also different according to onset age. The aims of this study are to explore the differences of etiology, behavioral features and burdens of their caregivers between EOD and LOD. Methods: We enrolled 1341 clinically demented patients who satisfied working inclusion criteria from 31 dementia centers nationwide in Korea. 200 EOD (age; 58.3 + 5.8, 76 male, education; 10.3 + 3.4 years, MMSE; 20.9 + 4.9) and 1133 LOD (age; 76.5 + 5.7, 394 male, education; 5.4 + 3.8, MMSE; 18.7 + 5.3) patients were evaluated using an electronic case report form which include information about demographic findings, probable etiologic disease, general cognitive status, neuropsychiatric inventory (NPI) and caregiver burden. Their cognitive tests, NPI and the assessment of caregiver burden were followed after 3 months and 6 months. Results: The most frequent etiologic disease in both group was Alzheimer’s disease (63.5% in EOD and 63.3% in LOD). Multi-infarct dementia was more popular in LOD, but Frontotemporal dementia in EOD. Among the items of NPI, delusion, hallucination and abberant motor behavior were more frequent in LOD (p<0.01). Despite of rarer prevalence, caregiver of EOD patients had greater stress for delusion, abberant motor behavior and abnormal sleep behavior than LOD. The MMSE score was negatively correlated with the
P587
frequency and severity of NPI and caregiver burden (p<0.001). Conclusions: We suggest that future study including EOD has to
be differently approached to LOD in aspect of patients and caregiver. It should be warranted to establish the recommendation for caregiver of EOD patients who have been overlooked.
P1-401
THE CORRELATION OF DIABETIC STATUS, ISCHEMIC AND ATROPHIC BURDENS ON BRAIN MRI AND COGNITIVE DECLINE IN SEVENTH DECADE DIABETIC PATIENTS WITH COGNITIVE IMPAIRMENT: 1-YEAR PROSPECTIVE, OBSERVATIONAL STUDY
Jay Cheol Kwon1, Kyungsoo Lee2, Yohan Jung1, Sungrae Cho1, Nackcheon Choi3, 1Changwon Fatima Hospital, Changwon, The Republic of Korea; 2Samsung Changwon Hospital, Changwon, The Republic of Korea; 3 Gyeongsang National University Hospital, Chinju, The Republic of Korea. Contact e-mail: [email protected] Background: Although the increasing number of clinical researches about diabetes and cognition, many limitations and debates have been exposed and yet revealed little. Also the contribution of Alzheimer-type and/or vascular pathology to cognitive declines has been remained unclear. The aim of this study was to evaluate the contributing factors correlated with cognitive declines in selected diabetic patients with cognitive impairments prospectively. Methods: After interviewing 286 diabetic patients using dementia screening questionnaire in their 7thdecades, we enrolled 49 subjects who have cognitive impairment (age¼64.7663.27(61-70), M:F¼26:23, education¼7.7464.53 years, K-MMSE¼ 25.3763.92, MoCA¼18.2464.69). Korean version mini-mental status examination (K-MMSE), MoCA and several laboratory examination of diabetes and lipid were tested and repeated after 6 and 12 months. All subjects were performed Brain MRI and scored visually focusing ischemia and atrophy. Results: The fluctuation index of fasting blood glucose(FBS) and glycosylated hemoglobin(HbA1c) were negatively correlated with cognitive change (p¼0.01, p¼0.02). And low density lipoprotein(LDL) level was negatively correlated with cognitive change(p¼0.02) but high density lipoprotein(HDL) was positively(p¼0.03). MRI factors focusing on white matter hyperintensities and medial temporal atrophy are not significantly correlated with cognitive declines. Conclusions: We concluded the fluctuation rather than mean value of blood glucose level are the possible predictor of cognitive declines in diabetic patients and suggested management strategy. There is a need for larger, quantitative, clinical-neuroimaging studies to improve knowledge of the complex contributions by vascular and Alzheimer pathologies in diabetic patients.
P1-402
THE CONSIDERATION ABOUT USEFULNESS OF MASS SCREENING FOR DEMENTIA
Hojin Choi1, Seung Hyun Kim1, Choongsup Shim2, 1College of Medicine, Hanyang University, Seoul, The Republic of Korea; 2 Kwangmyeong Sungae Hospital, Seoul, The Republic of Korea. Contact e-mail: [email protected] Background: With the increasing elderly population in Korea, the number of dementia patients is estimated to reach nearly a million by 2027. To resolve this problem, centers for dementia were
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 Results: Of 834 patients included in the analyses, n¼288 were NCI and n¼546 were MCI. ROC curve analysis revealed 8 items of the IQCODE most sensitive in discriminating MCI. Low sensitivity was observed in the discriminant indices of the P-AD8 (Area under the curve (AUC): 0.60, sensitivity: 54.4%, specificity: 65.1%, cutoff: 1), I-AD8 (AUC: 0.58, sensitivity: 45.6%, specificity: 70.8%, cut-off: 1), 16-item IQCODE (AUC: 0.56, sensitivity: 57.5%, specificity: 54.5%, cut-off: 3.03) and the 8-item IQCODE (AUC: 0.58, sensitivity: 55.5%, specificity: 56.9%, cut-off: 3.06). However, the sensitivities of the P-AD8, 16-item and 8item IQCODE were higher than the I-AD8 (p<0.001). Therefore, combination of the P-AD8 and 16-item IQCODE (AUC: 0.60, sensitivity: 79.1%, specificity: 38.8%) or 8-item IQCODE (AUC: 0.59, sensitivity: 78.1%, specificity: 39.2%) demonstrated increase in overall sensitivity. Though there were significant differences between the sensitivities of the two combinations (p¼0.030), comparison of AUC’s showed no differences (p¼0.899). Conclusions: The compensatory combination of the P-AD8 with the 8-item IQCODE improves overall sensitivity for detecting MCI. The absence of significant functional decline in the MCI criteria accounts for the poor AUC of each test. This indicates that tests designed to detect functional decline are not suitable to detect MCI.
P1-400
THE COMPARISONS OF ETIOLOGIES, CLINICAL FEATURES FOCUSING ON BEHAVIOR PROBLEM AND CAREGIVER BURDENS BETWEEN EARLY ONSET DEMENTIA (EOD) AND LATE ONSET DEMENTIA (LOD)
Jay Cheol Kwon1, Byunggun Kim2, Kyungsoo Lee3, Nack-cheon Choi4, Yohan Jung1, 1Changwon Fatima Hospital, Changwon, The Republic of Korea; 2Eulji University Hospital, Seoul, The Republic of Korea; 3Samsung Changwon Hispital, Changwon, The Republic of Korea; 4Gyeongsang National University Hospital, Chinju, The Republic of Korea. Contact e-mail: [email protected] Background: Although EOD and LOD have common etiologic dis-
ease, they may show the different clinical features including cognition and abnormal behavior. The burden of their caregivers could be also different according to onset age. The aims of this study are to explore the differences of etiology, behavioral features and burdens of their caregivers between EOD and LOD. Methods: We enrolled 1341 clinically demented patients who satisfied working inclusion criteria from 31 dementia centers nationwide in Korea. 200 EOD (age; 58.3 + 5.8, 76 male, education; 10.3 + 3.4 years, MMSE; 20.9 + 4.9) and 1133 LOD (age; 76.5 + 5.7, 394 male, education; 5.4 + 3.8, MMSE; 18.7 + 5.3) patients were evaluated using an electronic case report form which include information about demographic findings, probable etiologic disease, general cognitive status, neuropsychiatric inventory (NPI) and caregiver burden. Their cognitive tests, NPI and the assessment of caregiver burden were followed after 3 months and 6 months. Results: The most frequent etiologic disease in both group was Alzheimer’s disease (63.5% in EOD and 63.3% in LOD). Multi-infarct dementia was more popular in LOD, but Frontotemporal dementia in EOD. Among the items of NPI, delusion, hallucination and abberant motor behavior were more frequent in LOD (p<0.01). Despite of rarer prevalence, caregiver of EOD patients had greater stress for delusion, abberant motor behavior and abnormal sleep behavior than LOD. The MMSE score was negatively correlated with the
P587
frequency and severity of NPI and caregiver burden (p<0.001). Conclusions: We suggest that future study including EOD has to
be differently approached to LOD in aspect of patients and caregiver. It should be warranted to establish the recommendation for caregiver of EOD patients who have been overlooked.
P1-401
THE CORRELATION OF DIABETIC STATUS, ISCHEMIC AND ATROPHIC BURDENS ON BRAIN MRI AND COGNITIVE DECLINE IN SEVENTH DECADE DIABETIC PATIENTS WITH COGNITIVE IMPAIRMENT: 1-YEAR PROSPECTIVE, OBSERVATIONAL STUDY
Jay Cheol Kwon1, Kyungsoo Lee2, Yohan Jung1, Sungrae Cho1, Nackcheon Choi3, 1Changwon Fatima Hospital, Changwon, The Republic of Korea; 2Samsung Changwon Hospital, Changwon, The Republic of Korea; 3 Gyeongsang National University Hospital, Chinju, The Republic of Korea. Contact e-mail: [email protected] Background: Although the increasing number of clinical researches about diabetes and cognition, many limitations and debates have been exposed and yet revealed little. Also the contribution of Alzheimer-type and/or vascular pathology to cognitive declines has been remained unclear. The aim of this study was to evaluate the contributing factors correlated with cognitive declines in selected diabetic patients with cognitive impairments prospectively. Methods: After interviewing 286 diabetic patients using dementia screening questionnaire in their 7thdecades, we enrolled 49 subjects who have cognitive impairment (age¼64.7663.27(61-70), M:F¼26:23, education¼7.7464.53 years, K-MMSE¼ 25.3763.92, MoCA¼18.2464.69). Korean version mini-mental status examination (K-MMSE), MoCA and several laboratory examination of diabetes and lipid were tested and repeated after 6 and 12 months. All subjects were performed Brain MRI and scored visually focusing ischemia and atrophy. Results: The fluctuation index of fasting blood glucose(FBS) and glycosylated hemoglobin(HbA1c) were negatively correlated with cognitive change (p¼0.01, p¼0.02). And low density lipoprotein(LDL) level was negatively correlated with cognitive change(p¼0.02) but high density lipoprotein(HDL) was positively(p¼0.03). MRI factors focusing on white matter hyperintensities and medial temporal atrophy are not significantly correlated with cognitive declines. Conclusions: We concluded the fluctuation rather than mean value of blood glucose level are the possible predictor of cognitive declines in diabetic patients and suggested management strategy. There is a need for larger, quantitative, clinical-neuroimaging studies to improve knowledge of the complex contributions by vascular and Alzheimer pathologies in diabetic patients.
P1-402
THE CONSIDERATION ABOUT USEFULNESS OF MASS SCREENING FOR DEMENTIA
Hojin Choi1, Seung Hyun Kim1, Choongsup Shim2, 1College of Medicine, Hanyang University, Seoul, The Republic of Korea; 2 Kwangmyeong Sungae Hospital, Seoul, The Republic of Korea. Contact e-mail: [email protected] Background: With the increasing elderly population in Korea, the number of dementia patients is estimated to reach nearly a million by 2027. To resolve this problem, centers for dementia were