- Email: [email protected]
THE ROLE OF NEUROPSYCHIATRIC SYMPTOMS IN AD DIFFERENTIAL DIAGNOSIS
P372
Poster Presentations: Sunday, July 16, 2017
Trondheim, Norway; 6Norwegian National Advisory Unit on Ageing and Health, Oslo, Norway; 7Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom; 8Helse Fonna, Haugesund, Norway; 9University of Oslo, Oslo, Norway. Contact e-mail: [email protected] Background: Apathy is one of the most common behavioural and psychological symptoms of dementia. Prevalence of apathy in Alzheimer’s Disease (AD) is estimated to be 36% (range – 17%-82%) for individuals in nursing homes. When measured by the NPI, prevalence is 32% (range – 23%-48%). Although common, apathy continues to be under-diagnosed and under-researched. While thought to be co-morbid with depression, the literature supports apathy as a distinct clinical entity although the exact biological cause is unknown. As part of a larger ongoing international collaboration between King’s College London and University of Exeter in the UK and Innlandet Hospital Trust, Norwegian University of Science and Technology and the Norwegian National Advisory Unit on Ageing and Health in Norway, we present the apathy and depression data in a cohort of nursing home and community-based participants. Methods: Nursing home and community-based participants (n¼2313) with AD were assessed with the 12-item Neuropsychiatric Inventory (NPI). An NPI score of 0 represented no symptoms present. Score of each NPI subscale was calculated by multiplying severity by frequency. Participants’ characteristics, means, standard deviations (SD), Mini-Mental State Exam (MMSE), Clinical Dementia Rating (CDR) scale, NPI apathy and depression scores were analysed by descriptive statistics in SPSS. Results: For the whole cohort, mean age 6 SD was 81.6 6 7.38. 32.6% were male and 67.4% were female. The mean MMSE 6 SD was 15.6 6 7.99 and median CDR was 2. 49.3% had apathy and 46.7% had depression as measured by the NPI. Apathy occurred in 20.5% in isolation while 17.8% had depression alone. 28.0% of participants had both symptoms. Conclusions: There is a subset of people with AD that can have apathy without depression and vice versa, therefore supporting apathy as a separate clinical entity. Future work should be done to ascertain the extent of shared and unique biological correlates between the two symptoms.
P1-310
DIFFERENCES BETWEEN MONTREAL COGNITIVE ASSESSMENT AND MINIMENTAL STATE EXAMINATION IN REFLECTING COGNITIVE RESERVE
Jae Myeong Kang1, Jun-Young Lee2, Young-Sung Cho3, Soowon Park4, Bo Kyung Sohn5, Seong-Jin Cho1, Jae-Hong Lee6, 1Gachon University Gil Medical Center, Incheon, Republic of South Korea; 2SMG-SNU Boramae Medical Center, Seoul, Republic of South Korea; 3Seoul National University, Boramae Medical Center, Seoul, Republic of South Korea; 4 Sejong University, Seoul, Republic of South Korea; 5Seoul National University College of Medicine, Seoul, Republic of South Korea; 6Asan Medical Center, Seoul, Republic of South Korea. Contact e-mail: [email protected] Background: The Montreal cognitive assessment (MoCA) is known
to discriminate patients with mild cognitive impairment (MCI). Recently cognitive reserve (CR) is introduced to compensate the cognitive decline. We aimed to find out how well MoCA reflects CR and find differences between the MoCA and Mini-mental state examination (MMSE) in reflecting CR. Methods: MoCA, MMSE,
and Cognitive reserve index questionnaire (CRIq) were administered to 221 healthy participants. Normative data and associated factors of MoCA were determined. Correlation analysis of MoCA and CR was performed and a comparison of MoCA with MMSE in the degree of the reflection of CR was conducted. Results: MoCA reflected CR in education (b¼0.252, P<0.001), working (b¼0.156, P¼0.023) and total CR (b¼0.383, P<0.001) while MMSE reflected CR only in education (b¼0.299, P<0.001) and total CR (b¼0.373, P<0.001). MoCA reflected CR better than MMSE in total score of CR (Z¼2.30) and education domain (Z¼1.05). Conclusions: In this study, MoCA reflected CR better than MMSE. MoCA can be efficiently used to assess the early cognitive decline because it is sensitive to CR.
P1-311
THE ROLE OF NEUROPSYCHIATRIC SYMPTOMS IN AD DIFFERENTIAL DIAGNOSIS
Janne M. Papma1, Sanne Franzen1, John C. van Swieten1, Rik Ossenkoppele2, Michiel Coesmans1, Esther van den Berg1, 1 Erasmus MC, Rotterdam, Netherlands; 2Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, Netherlands. Contact e-mail: [email protected] Background: Neuropsychiatric symptoms (NPS) are present in the vast
majority (>80%) of patients with Alzheimer’s disease (AD), and can be the earliest AD symptoms to occur (i.e. mild behavioral impairment). Though the awareness for NPS in AD has grown in recent years, AD is still primarily defined as a cognitive disorder. This has important consequences for daily clinical practice, as the underrecognition of NPS in AD complicates the differential diagnosis (dd.) with other neurodegenerative disorders like frontotemporal dementia (FTD) and Lewy body dementia (DLB), or primary psychiatric disorders. In the present study we examined the NPS profile of AD patients, and compared this with NPS profiles in FTD patients, DLB patients, and patients with a dd. of - AD and FTD/DLB- or - AD and psychiatric disorder - upon presentation. Methods: From the Alzheimer Center Rotterdam patient registry we selected patients with a clinical diagnosis of (presenile) AD, behavioral variant (bv)FTD, DLB or primary
Poster Presentations: Sunday, July 16, 2017
P373
Table 1 Presence of NPS in AD, bvFTD, DLB, psychiatric disorder, dd. AD-FTD/DLB, dd. AD-psychiatric disorder
N Leeftijd MMSE Sex, female (%) Presence Delusions (%) Presence Hallucinations (%) Presence Agitation/aggression (%) Presence Depression/dysphoria (%) Presence Anxiety (%) Presence Elation/euphoria (%) Presence Apathy/indifference (%) Presence Disinhibition (%) Presence Irritability/lability (%) Presence Aberrant motor behavior (%) Presence sleep problems (%) Presence Appetite and eating disorders (%)
AD
bvFTD
DLB
Psychiatric disorder
Dd AD- dementia
Dd AD-psych
P value
46 65.7 (9.2)a 20.9 (5.9)a,b 15 (33) 10 (22) 4 (9) 12 (26) 22 (48) 18 (39) 11 (24) 24 (52) 16 (35) 22 (48) 11 (24) 10 (24) 22 (48)
28 61.7 (10.5) 24.1 (5.1)a 9 (32) 10 (36) 4 (14) 16 (57) 9 (32) 11 (39) 9 (32) 25 (89)* 19 (68)* 17 (61) 9 (32) 12 (43) 19 (68)
11 65.6 (7.5)a 23.5 (3.7) 5 (46) 2 (18) 5 (45) 3 (27) 7 (64) 2 (18) 3 (27) 6 (55) 2 (18) 7 (64) 4 (40)c 4 (40)c 6 (55)
48 58.4 (8.4) 26.5 (2.8) 16 (33) 13 (28) 8 (17) 20 (42) 37 (77)* 18 (38) 9 (19)c 27 (57)c 22 (47)c 30 (64)c 12 (26)c 25 (54)c 18 (39)c
22 65.1 (8.7 )a 22.8 (4.6)a 7 (32) 3 (14) 2 (9) 9 (41) 11 (50) 5 (23) 7 (32) 13 (59) 7 (32) 10 (46) 8 (36) 8 (36) 14 (64)
11 62.7 (11.0) 21.8 (4.3)a 7 (64) 3 (27) 2 (18) 5 (46) 9 (82)* 4 (36) 2 (18) 5 (46) 3 (27) 8 (73) 3 (27) 5 (46) 5(46)
0.003 <0.001 0.139 0.552 0.070 0.151 0.001 0.618 0.776 0.029 0.018 0.400 0.824 0.115 0.182
a
Compared with psychiatric diagnosis; bCompared with bvFTD; cMissing in 1-2 subject; *Significantly different from AD.
psychiatric disorder underlying cognitive disorders, and an available Neuropsychiatric Inventory (NPI-Q). In patient records we checked the clinical presentation at first appointment, and subdivided patients into primarily AD presentation (cognitive presentation, n ¼46), primarily bvFTD presentation (n ¼28), primarily DLB presentation (n ¼ 11), primarily psychiatric disorder (n ¼ 11), or dd. AD-FTD/DLB (n ¼ 22), and dd. AD-psychiatric disorder. We examined potential differences or similarities in the presence of NPI symptoms. Results: Groups differed significantly for the presence of depression/dysphoria (p ¼ 0.001), apathy/indifference (p ¼ 0.029) and disinhibition (p ¼ 0.018) (Table 1). When we compared AD presentation with the other presentations for these specific NPS; AD presentation showed less depression than primary psychiatric disorder and dd. AD-psychiatric disorder, less apathy/indifference and disinhibition than bvFTD patients (Table 1). Conclusions: Our exploratory analyses between patients primarily presenting with typical (cognitive) AD, and clinical presentations like FTD, DLB and primary psychiatric disorder, in which NPS are part of the clinical consensus criteria, reveal potential problems for differential diagnosis, as there was overlap in the presence of NPS between groups. Presence of depressive symptoms was shown to lead to a clinical working diagnosis or dd. of psychiatric disorder.
P1-312
EFFECT OF COCHLEAR IMPLANTATION ON COGNITIVE FUNCTION: A PRELIMINARY STUDY USING NONVERBAL COMMUNICATION
Jeewon Suh, SangHak Yi, Young Ho Park, Moon-Ku Han, SangYun Kim, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of South Korea. Contact e-mail: [email protected] Background: Cognitive impairment and hearing loss are two distinct neurologic conditions that are associated with aging. Several recent studies support the notion that the severity of hearing loss in older adults is independently linked to accelerated cognitive decline. Also many publications have shown that cochlear implants improve cognitive function. Whether the work of cochlear implants affects neuropsychological tests or not is not known. Methods: Participants comprised 5 cochlear implants users. The neuropsychological test was conducted twice at intervals of 4 months. Two participants per-
formed the first test with the hearing aids turned on and the second test with the hearing aids turned off. Three participants turned off their hearing aids in the first test and did a second test with the hearing aids on. Six neuropsychological test were used: a) Mini-Mental State Examination b) Color Word Stoop Test c) Trail Making Test d) Rey Complex Figure Test e) Hopkins Verbal Learning Test f) Digit Span Test. All the test methods were presented to the screen without any verbal instructions. Results: There was no significant difference in the neuropsychological test at intervals of 4 months. Although the difference was statistically insignificant, the scores in stroop color reading test and trail making test, the score improved from average 85 to 97 and 29 to 33 respectively when the cochlear implant was turned on. Conclusions: The presence of cochlear implants has no effect on the neuropsychological test. Although there Table 1 Evaluation of the new test battery Cognitive function
Cl-on
Cl-off
P
Attention Verbal (Digit span) Verbal (HVLT)
F: 5.6060.55 B: 4.4061.14 I: 17.0063.08 D: 4.6061.52 R: 21.006 1.58 I: 16.5066.63 D: 16.6067.49 R: 20.2061.30 31.8064.49
F: 5.4060.55 B: 3.8061.30 I: 17.0065.10 D: 4.8063.27 R: 20.8061.92 I: 16.8068.11 D: 15.1067.72 R: 18.206 1.79 32.2062.28
0.317 0.180 0.893 0.892 0.705 0.715 0.686 0.066 0.655
Stroop-R: 112.060.00 Stroop-CR: 97.4628.77 TMT-A: 29.006 19.03 TMT-B: 37.25619.38 27.8062.17
Stroop-R: 112.060.00 Stroop-CR: 85.40626.04 TMT-A: 33.00621.39 TMT-B: 39.80619.64 27.6062.30
1.000
Memory Visual (REY) Visuospatial Function
Frontal lobe Function
MMSE
0.225 0.068 1.000 0.783
CI: Cochlear implant; F: Forward; B: Backward; HVLT: Hopkins verbal learning test; I: Immediate recall; D: Delayed recall; R: recognition; StroopR: Stroop reading test; Stroop-CR: Stroop color reading test; TMT: Trail making test; MMSE: Mini-mental state examination.
Poster Presentations: Sunday, July 16, 2017
Trondheim, Norway; 6Norwegian National Advisory Unit on Ageing and Health, Oslo, Norway; 7Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom; 8Helse Fonna, Haugesund, Norway; 9University of Oslo, Oslo, Norway. Contact e-mail: [email protected] Background: Apathy is one of the most common behavioural and psychological symptoms of dementia. Prevalence of apathy in Alzheimer’s Disease (AD) is estimated to be 36% (range – 17%-82%) for individuals in nursing homes. When measured by the NPI, prevalence is 32% (range – 23%-48%). Although common, apathy continues to be under-diagnosed and under-researched. While thought to be co-morbid with depression, the literature supports apathy as a distinct clinical entity although the exact biological cause is unknown. As part of a larger ongoing international collaboration between King’s College London and University of Exeter in the UK and Innlandet Hospital Trust, Norwegian University of Science and Technology and the Norwegian National Advisory Unit on Ageing and Health in Norway, we present the apathy and depression data in a cohort of nursing home and community-based participants. Methods: Nursing home and community-based participants (n¼2313) with AD were assessed with the 12-item Neuropsychiatric Inventory (NPI). An NPI score of 0 represented no symptoms present. Score of each NPI subscale was calculated by multiplying severity by frequency. Participants’ characteristics, means, standard deviations (SD), Mini-Mental State Exam (MMSE), Clinical Dementia Rating (CDR) scale, NPI apathy and depression scores were analysed by descriptive statistics in SPSS. Results: For the whole cohort, mean age 6 SD was 81.6 6 7.38. 32.6% were male and 67.4% were female. The mean MMSE 6 SD was 15.6 6 7.99 and median CDR was 2. 49.3% had apathy and 46.7% had depression as measured by the NPI. Apathy occurred in 20.5% in isolation while 17.8% had depression alone. 28.0% of participants had both symptoms. Conclusions: There is a subset of people with AD that can have apathy without depression and vice versa, therefore supporting apathy as a separate clinical entity. Future work should be done to ascertain the extent of shared and unique biological correlates between the two symptoms.
P1-310
DIFFERENCES BETWEEN MONTREAL COGNITIVE ASSESSMENT AND MINIMENTAL STATE EXAMINATION IN REFLECTING COGNITIVE RESERVE
Jae Myeong Kang1, Jun-Young Lee2, Young-Sung Cho3, Soowon Park4, Bo Kyung Sohn5, Seong-Jin Cho1, Jae-Hong Lee6, 1Gachon University Gil Medical Center, Incheon, Republic of South Korea; 2SMG-SNU Boramae Medical Center, Seoul, Republic of South Korea; 3Seoul National University, Boramae Medical Center, Seoul, Republic of South Korea; 4 Sejong University, Seoul, Republic of South Korea; 5Seoul National University College of Medicine, Seoul, Republic of South Korea; 6Asan Medical Center, Seoul, Republic of South Korea. Contact e-mail: [email protected] Background: The Montreal cognitive assessment (MoCA) is known
to discriminate patients with mild cognitive impairment (MCI). Recently cognitive reserve (CR) is introduced to compensate the cognitive decline. We aimed to find out how well MoCA reflects CR and find differences between the MoCA and Mini-mental state examination (MMSE) in reflecting CR. Methods: MoCA, MMSE,
and Cognitive reserve index questionnaire (CRIq) were administered to 221 healthy participants. Normative data and associated factors of MoCA were determined. Correlation analysis of MoCA and CR was performed and a comparison of MoCA with MMSE in the degree of the reflection of CR was conducted. Results: MoCA reflected CR in education (b¼0.252, P<0.001), working (b¼0.156, P¼0.023) and total CR (b¼0.383, P<0.001) while MMSE reflected CR only in education (b¼0.299, P<0.001) and total CR (b¼0.373, P<0.001). MoCA reflected CR better than MMSE in total score of CR (Z¼2.30) and education domain (Z¼1.05). Conclusions: In this study, MoCA reflected CR better than MMSE. MoCA can be efficiently used to assess the early cognitive decline because it is sensitive to CR.
P1-311
THE ROLE OF NEUROPSYCHIATRIC SYMPTOMS IN AD DIFFERENTIAL DIAGNOSIS
Janne M. Papma1, Sanne Franzen1, John C. van Swieten1, Rik Ossenkoppele2, Michiel Coesmans1, Esther van den Berg1, 1 Erasmus MC, Rotterdam, Netherlands; 2Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, Netherlands. Contact e-mail: [email protected] Background: Neuropsychiatric symptoms (NPS) are present in the vast
majority (>80%) of patients with Alzheimer’s disease (AD), and can be the earliest AD symptoms to occur (i.e. mild behavioral impairment). Though the awareness for NPS in AD has grown in recent years, AD is still primarily defined as a cognitive disorder. This has important consequences for daily clinical practice, as the underrecognition of NPS in AD complicates the differential diagnosis (dd.) with other neurodegenerative disorders like frontotemporal dementia (FTD) and Lewy body dementia (DLB), or primary psychiatric disorders. In the present study we examined the NPS profile of AD patients, and compared this with NPS profiles in FTD patients, DLB patients, and patients with a dd. of - AD and FTD/DLB- or - AD and psychiatric disorder - upon presentation. Methods: From the Alzheimer Center Rotterdam patient registry we selected patients with a clinical diagnosis of (presenile) AD, behavioral variant (bv)FTD, DLB or primary
Poster Presentations: Sunday, July 16, 2017
P373
Table 1 Presence of NPS in AD, bvFTD, DLB, psychiatric disorder, dd. AD-FTD/DLB, dd. AD-psychiatric disorder
N Leeftijd MMSE Sex, female (%) Presence Delusions (%) Presence Hallucinations (%) Presence Agitation/aggression (%) Presence Depression/dysphoria (%) Presence Anxiety (%) Presence Elation/euphoria (%) Presence Apathy/indifference (%) Presence Disinhibition (%) Presence Irritability/lability (%) Presence Aberrant motor behavior (%) Presence sleep problems (%) Presence Appetite and eating disorders (%)
AD
bvFTD
DLB
Psychiatric disorder
Dd AD- dementia
Dd AD-psych
P value
46 65.7 (9.2)a 20.9 (5.9)a,b 15 (33) 10 (22) 4 (9) 12 (26) 22 (48) 18 (39) 11 (24) 24 (52) 16 (35) 22 (48) 11 (24) 10 (24) 22 (48)
28 61.7 (10.5) 24.1 (5.1)a 9 (32) 10 (36) 4 (14) 16 (57) 9 (32) 11 (39) 9 (32) 25 (89)* 19 (68)* 17 (61) 9 (32) 12 (43) 19 (68)
11 65.6 (7.5)a 23.5 (3.7) 5 (46) 2 (18) 5 (45) 3 (27) 7 (64) 2 (18) 3 (27) 6 (55) 2 (18) 7 (64) 4 (40)c 4 (40)c 6 (55)
48 58.4 (8.4) 26.5 (2.8) 16 (33) 13 (28) 8 (17) 20 (42) 37 (77)* 18 (38) 9 (19)c 27 (57)c 22 (47)c 30 (64)c 12 (26)c 25 (54)c 18 (39)c
22 65.1 (8.7 )a 22.8 (4.6)a 7 (32) 3 (14) 2 (9) 9 (41) 11 (50) 5 (23) 7 (32) 13 (59) 7 (32) 10 (46) 8 (36) 8 (36) 14 (64)
11 62.7 (11.0) 21.8 (4.3)a 7 (64) 3 (27) 2 (18) 5 (46) 9 (82)* 4 (36) 2 (18) 5 (46) 3 (27) 8 (73) 3 (27) 5 (46) 5(46)
0.003 <0.001 0.139 0.552 0.070 0.151 0.001 0.618 0.776 0.029 0.018 0.400 0.824 0.115 0.182
a
Compared with psychiatric diagnosis; bCompared with bvFTD; cMissing in 1-2 subject; *Significantly different from AD.
psychiatric disorder underlying cognitive disorders, and an available Neuropsychiatric Inventory (NPI-Q). In patient records we checked the clinical presentation at first appointment, and subdivided patients into primarily AD presentation (cognitive presentation, n ¼46), primarily bvFTD presentation (n ¼28), primarily DLB presentation (n ¼ 11), primarily psychiatric disorder (n ¼ 11), or dd. AD-FTD/DLB (n ¼ 22), and dd. AD-psychiatric disorder. We examined potential differences or similarities in the presence of NPI symptoms. Results: Groups differed significantly for the presence of depression/dysphoria (p ¼ 0.001), apathy/indifference (p ¼ 0.029) and disinhibition (p ¼ 0.018) (Table 1). When we compared AD presentation with the other presentations for these specific NPS; AD presentation showed less depression than primary psychiatric disorder and dd. AD-psychiatric disorder, less apathy/indifference and disinhibition than bvFTD patients (Table 1). Conclusions: Our exploratory analyses between patients primarily presenting with typical (cognitive) AD, and clinical presentations like FTD, DLB and primary psychiatric disorder, in which NPS are part of the clinical consensus criteria, reveal potential problems for differential diagnosis, as there was overlap in the presence of NPS between groups. Presence of depressive symptoms was shown to lead to a clinical working diagnosis or dd. of psychiatric disorder.
P1-312
EFFECT OF COCHLEAR IMPLANTATION ON COGNITIVE FUNCTION: A PRELIMINARY STUDY USING NONVERBAL COMMUNICATION
Jeewon Suh, SangHak Yi, Young Ho Park, Moon-Ku Han, SangYun Kim, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of South Korea. Contact e-mail: [email protected] Background: Cognitive impairment and hearing loss are two distinct neurologic conditions that are associated with aging. Several recent studies support the notion that the severity of hearing loss in older adults is independently linked to accelerated cognitive decline. Also many publications have shown that cochlear implants improve cognitive function. Whether the work of cochlear implants affects neuropsychological tests or not is not known. Methods: Participants comprised 5 cochlear implants users. The neuropsychological test was conducted twice at intervals of 4 months. Two participants per-
formed the first test with the hearing aids turned on and the second test with the hearing aids turned off. Three participants turned off their hearing aids in the first test and did a second test with the hearing aids on. Six neuropsychological test were used: a) Mini-Mental State Examination b) Color Word Stoop Test c) Trail Making Test d) Rey Complex Figure Test e) Hopkins Verbal Learning Test f) Digit Span Test. All the test methods were presented to the screen without any verbal instructions. Results: There was no significant difference in the neuropsychological test at intervals of 4 months. Although the difference was statistically insignificant, the scores in stroop color reading test and trail making test, the score improved from average 85 to 97 and 29 to 33 respectively when the cochlear implant was turned on. Conclusions: The presence of cochlear implants has no effect on the neuropsychological test. Although there Table 1 Evaluation of the new test battery Cognitive function
Cl-on
Cl-off
P
Attention Verbal (Digit span) Verbal (HVLT)
F: 5.6060.55 B: 4.4061.14 I: 17.0063.08 D: 4.6061.52 R: 21.006 1.58 I: 16.5066.63 D: 16.6067.49 R: 20.2061.30 31.8064.49
F: 5.4060.55 B: 3.8061.30 I: 17.0065.10 D: 4.8063.27 R: 20.8061.92 I: 16.8068.11 D: 15.1067.72 R: 18.206 1.79 32.2062.28
0.317 0.180 0.893 0.892 0.705 0.715 0.686 0.066 0.655
Stroop-R: 112.060.00 Stroop-CR: 97.4628.77 TMT-A: 29.006 19.03 TMT-B: 37.25619.38 27.8062.17
Stroop-R: 112.060.00 Stroop-CR: 85.40626.04 TMT-A: 33.00621.39 TMT-B: 39.80619.64 27.6062.30
1.000
Memory Visual (REY) Visuospatial Function
Frontal lobe Function
MMSE
0.225 0.068 1.000 0.783
CI: Cochlear implant; F: Forward; B: Backward; HVLT: Hopkins verbal learning test; I: Immediate recall; D: Delayed recall; R: recognition; StroopR: Stroop reading test; Stroop-CR: Stroop color reading test; TMT: Trail making test; MMSE: Mini-mental state examination.