- Email: [email protected]
Visualising the emergence of posterior cortical atrophy
Poster Presentations P1 53%), 6 (35%) were suspected of having VaD AND 2 (12%) were thought to be related to systemic disease. Estimated dementia prevalence in those over 60years of age showed large differences between urban (3%) and rural sites (7-16%), which were not explained by gender, ethnicity or socioeconomic status. However, rural areas are disproportionally populated by older and less educated participants, who have less access to health care. Healthier diets are also more likely to be consumed by the more affluent, relatively younger Jakarta based population. Conclusions: These studies showed that our short cheap and sensitive screening battery (15-20 min) can be used for dementia screening in rural Java and possibly other developing countries.
P1-154
IS THERE A RELATIONSHIP BETWEEN NONALCOHOLIC FATTY LIVER DISEASE, THYROID PATHOLOGY AND MILD COGNITIVE IMPAIRMENT? A ROMANIAN PROSPECTIVE STUDY
Ioana Ioancio1, Luiza Spiru2, Razvan Trascu3, 1Ana Aslan International Academy of Aging, Bucharest; 2Ana Aslan International Academy of Ageing, Bucharest; 3Ana Aslan International Academy of Ageing, Bucharest. Background: The mechanisms potentially responsible for accelerated atherogenesis in nonalcoholic fatty liver disease (NAFLD) probably originate in the expanded visceral adipose tissue, with the liver being both the target of the resulting systemic abnormalities and a source of proatherogenic molecules that amplify the arterial damage. NAFLD has emerged as a growing public health problem worldwide. Increases in morbidity and mortality due to cardiovascular disease are probably among the most important clinical features associated with NAFLD. Our prospective study investigated the link between NAFLD, thyroid pathology and the risk to develop mild cognitive impairment (MCI). Methods: The study included 83 patients (66.2% females, mean age 62.3 years), diagnosed with non-alcoholic fatty liver disease, referred to the Memory Clinic in Bucharest; we assessed the incidences of co-morbidities and cognitive diseases. Results: Over one third (38%) of patients were obese and 72% met the diagnostic criteria of metabolic syndrome; 32.5% had MCI and 21.68% patients had different types of dementia. The most frequent co-morbidities associated with NAFDL were: hypertension (47.31%), diabetes mellitus (17.43%), thyroid pathology (14.94 %), hyperlypemia (33.2%), atherosclerosis (i.e. carotid stenosis and obstructive arterial disease - 8.3%). Anxiety and depression were detected in 54.2% of patients. Conclusions: The association of NAFLD with cardiovascular and thyroid disorders is a significant risk factor for the development of MCI. These outcomes may have important impact on prediction, prevention and early diagnosis of MCI. A multifactorial approach of the treatment of NAFDL is required, especially against cardiovascular and metabolic risk factors. Evaluation of the thyroid function is also important as a powerful tool in the early diagnosis of cognitive impairment in patients associating NAFDL.
P1-155
CLINICAL APPLICABILITY OF EEG IN DIFFERENTIAL DIAGNOSIS OF COGNITIVE IMPAIRMENT AND DEMENTIA
Gısli H olmar J ohannesson1, Gısli Johannesson1, Kristinn Johnsen1, ıs Emilsdottir1, J on Snædal2, Halla Helgad ottir1, Nicolas Blin1, Asd 2 1 Thorkell Gudmundsson , Mentis Cura, Reykjavik; 2Mentis Cura, Reykjavik; 2National University Hospital, Reykjavik.
S161
Background: One of the main tasks in the diagnostic work up of cognitive impairment and dementia is to differentiate between the various causes but the current criteria for diagnosis of the most prevalent forms of dementia are of different accuracy and up to 10% of cases are difficult to diagnose with certainty (Knopman DS et al Neurology 2001;56:1143-53.) We present a diagnostic method which can provide support for differential diagnosis into one of the following eight categories: Normal (NRM), Alzheimer’s disease (AD), stable Mild Cognitive Impairment (stable for > 24 months ¼ sMCI), Progressive MCI (converting to dementia within 24 months ¼ pMCI), Vascular Dementia (VaD), Lewy-body/Parkinson’s (DLBP), depression (DPR) and Frontal Lobe Dementia (FLD). Methods: 1050 EEG registrations have been collected into an EEG database. All participants are in the age range of 50 - 90 years. The individuals in the clinical groups were diagnosed at a memory clinic and the NRM individuals were sought from the community. They were not demented and showed no signs of cognitive impairment. Statistical pattern recognition (SPR) was used to create classifiers using selected features from 1120 features of the EEG registration. For all binary comparisons of two distinct groups, a total of 28 comparisons, a numeric index from 0-100 was established to describe the likelihood of an individual belonging to one of the two groups being compared. Results: The diagnostic accuracy of the 28 comparisons all fall within the range 73%-97%. The accuracy is estimated using ten-fold cross validation. Thus it is possible to create a table with the results of the 28 classifications and use it to predict which group a given individual most likely belongs to. Clinical examples illustrate how this technique is applied for differential diagnosis. Conclusions: Following a more substantial clinical validation and an easy access to the methodology, we expect this application of clinical EEG in support for differential diagnosis of dementia to become a realistic first step in the full clinical workup of patients with cognitive impairment and dementia. The underlying technology is well known, widely available and inexpensive in relation to other imaging techniques.
P1-156
VISUALISING THE EMERGENCE OF POSTERIOR CORTICAL ATROPHY
Jonathan Kennedy1, Manja Lehmann2, Sebastian Crutch3, Nick Fox4, Hilary A. Archer5, Magdalena Sokolska5, 1Dementia Research Centre, London; 2University College London, London; 3University College London, London; 4Dementia Research Centre, UCL Institute of Neurology, London; 5 University College London, London. Background: Posterior cortical atrophy (PCA) is a progressive neurodegenerative condition characterized clinically by prominent impairments of space perception, object perception, and other posterior cognitive functions in the context of relatively spared episodic memory. We report the emergence of PCA in a subject from a longitudinal study of subjective memory complaints. Methods: Mr CE underwent annual assessments, over 5 years, involving a clinical and neuropsychological assessment and a volumetric T1-weighted MRI brain scan. MR images were segmented and co-registered to provide whole brain atrophy rates were also using the boundary shift integral. Non-linear registration of serial imaging to baseline was performed producing voxel-compression maps in order to localise any cerebral changes. Results: On his first visit CE, a 61 year-old man, reported a 5 year history of difficulties with episodic memory but baseline neuropsychometry was normal. His initial MRI scan showed no atrophy or other pathology. At visits 2 and 3 there was little change but by visit 4 he complained of difficulty using an analogue watch and a tendency to lose his place whilst reading. At visit 5 his symptoms had progressed and he now reported difficulty ironing his shirts. Neuropsychological testing then revealed a notable divergence between performance on tasks with and without a visual component. Visuospatial processing became impaired and visuoperceptual processing deteriorated. Verbal memory tasks remained at average or above whilst visual memory tasks became impaired or declined
S162
Poster Presentations P1 had superior performance in MCI (AD8: Sn 54.3, Sp 80.4, AUC 0.74; AD7-A: Sn 74.3, Sp 66.7, AUC 0.78; AD7-B: Sn 82.9 Sp 66.7, AUC 0.81). Conclusions: Certain items in the AD8 informant interview can be susceptible to cultural bias. The resultant impact on its overall reliability and diagnostic performance, especially in the MCI stage, can be mitigated by modification of affected items.
P1-158
throughout the study. Non-linear registration of his serial MR scans revealed a posterior-anterior gradient of loss by visit 2, with early changes in inferior temporal and superior parietal regions spreading later to affect the inferior parietal and occipital lobes. A mean of the annual whole brain atrophy rates across the study was 0.94% (normal age matched atrophy rate ¼ 0.32%). Based on the young age of onset, progressive visual dysfunction and neuroimaging evidence of occipito-parieto-temporal atrophy, a diagnosis of PCA attributable to probable AD was made. Conclusions: The present case represents a unique opportunity to study the clinical and neuropsychological emergence of PCA. PCA may have a very focal onset but subtle cognitive complaints and structural losses may precede even MCI criteria by some years. Serial neuroimaging and neuropsychological assessment may aid allow earlier diagnosis when disease modifying treatments may be more effective.
P1-157
THE AD8 INFORMANT INTERVIEW: INFLUENCE OF CULTURAL BIAS ON RELIABILITY AND DIAGNOSTIC PERFORMANCE IN EARLY COGNITIVE IMPAIRMENT (ECI)
Wee Shiong Lim1, Mei Sian Chong2, Peng Chew Mark Chan3, Laura Tay4, 1 Tan Tock Seng Hospital, Singapore; 2Tan Tock Seng Hospital, Singapore; 3 Tan Tock Seng Hospital, Singapore; 4Tan Tock Seng Hospital. Background: Although widely regarded as being less susceptible to transcultural factors than performance based screening measures, item adaptation may be necessary when applying an informant based interview such as the AD8 to a different cultural setting. We aim to ascertain the reliability and diagnostic performance in ECI of the AD8 compared with culturallyadapted versions in a memory clinic sample of predominantly Chinese ethnicity. Methods: We evaluated 339 patient-informant dyads, comprising 53 cognitively intact and 286 ECI subjects [40 with mild cognitive impairment (MCI); 246 with early dementia (Clinical Dementia Rating 0.5-1.0)]. Using a combination of clinical judgment, reliability tests and factor analysis, we derive two modified 7-item versions: i) AD7-A: single item on planning, organization and problem solving replacing 2 items on executive function (learning how to use gadgets or appliances, and problems with judgment); and ii) AD7-B: as per AD7-A, but substituting item on disorientation to time with disorientation to place. We compared the factor structure, reliability and ROC curve-derived sensitivity, specificity and AUC between AD8 and the two modified versions. Results: Factor analysis revealed an optimal one-factor structure for all 3 versions, with degree of variance accounted for by the single factor higher in the modified versions (52%) compared with AD8 (49%). Despite being briefer than the AD8, the 7-item modified versions displayed higher reliability (Cronbach’s alpha: AD8 0.82, AD7-A 0.84, AD7-B 0.84). All 3 versions demonstrated good diagnostic performance in ECI (AD8: Sn 82.7, Sp 90.2, AUC 0.93; AD7-A: Sn 90.2, Sp 82.4, AUC 0.93; AD7-B: Sn 83.5 Sp 90.2, AUC 0.94). When analyzed by subgroups, there was no difference in diagnostic performance in early dementia (AUC ¼ 0.96 for all 3 versions); however, both modified versions
VALIDATION OF THE TURKISH VERSION OF THE ADDENBROOKE’S COGNITIVE EXAMINATION IN TURKEY
Ebru Mihci1, Hakan Gurvit2, Basar Bilgic2, Hale Alpaslan2, Ayfer Tumac2, Sinem Yildiz2, Pinar Unsalan2, Sukriye Akca Kalem2, Oget Oktem Tanor2, 1 Akdeniz University, Antalya; 2Istanbul University, Istanbul. Background: Addenbrooke’s Cognitive Examination-Revised (ACE-R) is a brief bedside cognitive screening test, which is shown to be specific and sensitive instrument not only for the diagnosis of dementia but also mild cognitive impairment (MCI). The aim of the present study was to validate the use of the Turkish version of ACE-R. Methods: We applied the adapted Turkish version of the ACE-R to 204 individuals comprising three groups: mild cognitive impairment (MCI; n ¼ 45), mild Alzheimer’s disease (AD; n ¼ 83) and healthy controls (HC; n ¼ 76). Total ACE-R score and subscores were statistically compared statistically and sensitivity, specificity, area under curve (AUC) and reliability were calculated. Results: The reliability of the ACE-R was very good (a-coefficient 0.86). Overall the mean of the total ACE-Rscore of the AD group (57.9615.3) was significantly different than the other 2 groups, but comparable between the MCI (78.668.6)and HC (82.866.9) groups. When only the highly educated (>11 years) male subgroups of the MCI and HC groups were compared the difference became significant. We found that the Turkish ACE-R at cut-off point of 73 has a sensitivity of 92% and specificity of 80% indiscriminating AD from a normal population with a perfect AUC and at 69, the test has a sensitivity of 84% and a specificity of 75% in differentiating MCI from AD with a very good AUC. The cutoff point of 88 has a sensitivity of 83% and a specificity of 100% indiscriminating male MCI patients with more than11years of education from that of healthy controls with very good AUC. Conclusions: The Turkish version of the ACE-R is a useful screening test for discriminating demented patients from non-demented individuals. Its applicability in the differentiation of MCI patients from cognitively normal elderly individuals seems to be restricted into relatively high-educated males only. These findings are largely in line with the previous non-English adaption studies of ACE-R.
P1-159
DEMENTIA AND DEPRESSION: TWO EXISTING COMORBIDITIES
Hovhannes Manvelyan, Aleksandra Karapetyan, Avetis Avetisyan, Hasmik Hambardzumyan, Astghik Karapetyan, Mikhail Aghajanov, Yerevan State Medical Univeristy, Yerevan. Background: Dementia and depression have tight interactions especially in elderly. Patients with early hallmark of dementia onset starting with Mild Cognitive Impairment (MCI) often become depressed because of the overestimation of memory deficit. Depression, or mood swings, anxiety, negative emotions and stress are another often seeing conditions in elderly. Together in clinical practice coexisting dementia and depression often could be omitted or unintentionally misdiagnosed. Thus leads to wrong diagnosis and uneffective management Methods: 51 patient (30 women and 21 man, aged 72+/8) with dementia was selected for this study, all had cognitive impairment from mild to severe and impaired activities of daily living. The inclusion criteria were positive signs in clinical investigations, low scores on dementia scales, will to cooperation and ability to understand the questions asked. All patients went through thoughtful evaluation by Folstein’s MMSE, Blessed Dementia Scale, Hamilton and Beck’s Depression Scales. Results: We found MCI in 24 patients (47%), the rest had more profound deficit. Positive signs
P1-154
IS THERE A RELATIONSHIP BETWEEN NONALCOHOLIC FATTY LIVER DISEASE, THYROID PATHOLOGY AND MILD COGNITIVE IMPAIRMENT? A ROMANIAN PROSPECTIVE STUDY
Ioana Ioancio1, Luiza Spiru2, Razvan Trascu3, 1Ana Aslan International Academy of Aging, Bucharest; 2Ana Aslan International Academy of Ageing, Bucharest; 3Ana Aslan International Academy of Ageing, Bucharest. Background: The mechanisms potentially responsible for accelerated atherogenesis in nonalcoholic fatty liver disease (NAFLD) probably originate in the expanded visceral adipose tissue, with the liver being both the target of the resulting systemic abnormalities and a source of proatherogenic molecules that amplify the arterial damage. NAFLD has emerged as a growing public health problem worldwide. Increases in morbidity and mortality due to cardiovascular disease are probably among the most important clinical features associated with NAFLD. Our prospective study investigated the link between NAFLD, thyroid pathology and the risk to develop mild cognitive impairment (MCI). Methods: The study included 83 patients (66.2% females, mean age 62.3 years), diagnosed with non-alcoholic fatty liver disease, referred to the Memory Clinic in Bucharest; we assessed the incidences of co-morbidities and cognitive diseases. Results: Over one third (38%) of patients were obese and 72% met the diagnostic criteria of metabolic syndrome; 32.5% had MCI and 21.68% patients had different types of dementia. The most frequent co-morbidities associated with NAFDL were: hypertension (47.31%), diabetes mellitus (17.43%), thyroid pathology (14.94 %), hyperlypemia (33.2%), atherosclerosis (i.e. carotid stenosis and obstructive arterial disease - 8.3%). Anxiety and depression were detected in 54.2% of patients. Conclusions: The association of NAFLD with cardiovascular and thyroid disorders is a significant risk factor for the development of MCI. These outcomes may have important impact on prediction, prevention and early diagnosis of MCI. A multifactorial approach of the treatment of NAFDL is required, especially against cardiovascular and metabolic risk factors. Evaluation of the thyroid function is also important as a powerful tool in the early diagnosis of cognitive impairment in patients associating NAFDL.
P1-155
CLINICAL APPLICABILITY OF EEG IN DIFFERENTIAL DIAGNOSIS OF COGNITIVE IMPAIRMENT AND DEMENTIA
Gısli H olmar J ohannesson1, Gısli Johannesson1, Kristinn Johnsen1, ıs Emilsdottir1, J on Snædal2, Halla Helgad ottir1, Nicolas Blin1, Asd 2 1 Thorkell Gudmundsson , Mentis Cura, Reykjavik; 2Mentis Cura, Reykjavik; 2National University Hospital, Reykjavik.
S161
Background: One of the main tasks in the diagnostic work up of cognitive impairment and dementia is to differentiate between the various causes but the current criteria for diagnosis of the most prevalent forms of dementia are of different accuracy and up to 10% of cases are difficult to diagnose with certainty (Knopman DS et al Neurology 2001;56:1143-53.) We present a diagnostic method which can provide support for differential diagnosis into one of the following eight categories: Normal (NRM), Alzheimer’s disease (AD), stable Mild Cognitive Impairment (stable for > 24 months ¼ sMCI), Progressive MCI (converting to dementia within 24 months ¼ pMCI), Vascular Dementia (VaD), Lewy-body/Parkinson’s (DLBP), depression (DPR) and Frontal Lobe Dementia (FLD). Methods: 1050 EEG registrations have been collected into an EEG database. All participants are in the age range of 50 - 90 years. The individuals in the clinical groups were diagnosed at a memory clinic and the NRM individuals were sought from the community. They were not demented and showed no signs of cognitive impairment. Statistical pattern recognition (SPR) was used to create classifiers using selected features from 1120 features of the EEG registration. For all binary comparisons of two distinct groups, a total of 28 comparisons, a numeric index from 0-100 was established to describe the likelihood of an individual belonging to one of the two groups being compared. Results: The diagnostic accuracy of the 28 comparisons all fall within the range 73%-97%. The accuracy is estimated using ten-fold cross validation. Thus it is possible to create a table with the results of the 28 classifications and use it to predict which group a given individual most likely belongs to. Clinical examples illustrate how this technique is applied for differential diagnosis. Conclusions: Following a more substantial clinical validation and an easy access to the methodology, we expect this application of clinical EEG in support for differential diagnosis of dementia to become a realistic first step in the full clinical workup of patients with cognitive impairment and dementia. The underlying technology is well known, widely available and inexpensive in relation to other imaging techniques.
P1-156
VISUALISING THE EMERGENCE OF POSTERIOR CORTICAL ATROPHY
Jonathan Kennedy1, Manja Lehmann2, Sebastian Crutch3, Nick Fox4, Hilary A. Archer5, Magdalena Sokolska5, 1Dementia Research Centre, London; 2University College London, London; 3University College London, London; 4Dementia Research Centre, UCL Institute of Neurology, London; 5 University College London, London. Background: Posterior cortical atrophy (PCA) is a progressive neurodegenerative condition characterized clinically by prominent impairments of space perception, object perception, and other posterior cognitive functions in the context of relatively spared episodic memory. We report the emergence of PCA in a subject from a longitudinal study of subjective memory complaints. Methods: Mr CE underwent annual assessments, over 5 years, involving a clinical and neuropsychological assessment and a volumetric T1-weighted MRI brain scan. MR images were segmented and co-registered to provide whole brain atrophy rates were also using the boundary shift integral. Non-linear registration of serial imaging to baseline was performed producing voxel-compression maps in order to localise any cerebral changes. Results: On his first visit CE, a 61 year-old man, reported a 5 year history of difficulties with episodic memory but baseline neuropsychometry was normal. His initial MRI scan showed no atrophy or other pathology. At visits 2 and 3 there was little change but by visit 4 he complained of difficulty using an analogue watch and a tendency to lose his place whilst reading. At visit 5 his symptoms had progressed and he now reported difficulty ironing his shirts. Neuropsychological testing then revealed a notable divergence between performance on tasks with and without a visual component. Visuospatial processing became impaired and visuoperceptual processing deteriorated. Verbal memory tasks remained at average or above whilst visual memory tasks became impaired or declined
S162
Poster Presentations P1 had superior performance in MCI (AD8: Sn 54.3, Sp 80.4, AUC 0.74; AD7-A: Sn 74.3, Sp 66.7, AUC 0.78; AD7-B: Sn 82.9 Sp 66.7, AUC 0.81). Conclusions: Certain items in the AD8 informant interview can be susceptible to cultural bias. The resultant impact on its overall reliability and diagnostic performance, especially in the MCI stage, can be mitigated by modification of affected items.
P1-158
throughout the study. Non-linear registration of his serial MR scans revealed a posterior-anterior gradient of loss by visit 2, with early changes in inferior temporal and superior parietal regions spreading later to affect the inferior parietal and occipital lobes. A mean of the annual whole brain atrophy rates across the study was 0.94% (normal age matched atrophy rate ¼ 0.32%). Based on the young age of onset, progressive visual dysfunction and neuroimaging evidence of occipito-parieto-temporal atrophy, a diagnosis of PCA attributable to probable AD was made. Conclusions: The present case represents a unique opportunity to study the clinical and neuropsychological emergence of PCA. PCA may have a very focal onset but subtle cognitive complaints and structural losses may precede even MCI criteria by some years. Serial neuroimaging and neuropsychological assessment may aid allow earlier diagnosis when disease modifying treatments may be more effective.
P1-157
THE AD8 INFORMANT INTERVIEW: INFLUENCE OF CULTURAL BIAS ON RELIABILITY AND DIAGNOSTIC PERFORMANCE IN EARLY COGNITIVE IMPAIRMENT (ECI)
Wee Shiong Lim1, Mei Sian Chong2, Peng Chew Mark Chan3, Laura Tay4, 1 Tan Tock Seng Hospital, Singapore; 2Tan Tock Seng Hospital, Singapore; 3 Tan Tock Seng Hospital, Singapore; 4Tan Tock Seng Hospital. Background: Although widely regarded as being less susceptible to transcultural factors than performance based screening measures, item adaptation may be necessary when applying an informant based interview such as the AD8 to a different cultural setting. We aim to ascertain the reliability and diagnostic performance in ECI of the AD8 compared with culturallyadapted versions in a memory clinic sample of predominantly Chinese ethnicity. Methods: We evaluated 339 patient-informant dyads, comprising 53 cognitively intact and 286 ECI subjects [40 with mild cognitive impairment (MCI); 246 with early dementia (Clinical Dementia Rating 0.5-1.0)]. Using a combination of clinical judgment, reliability tests and factor analysis, we derive two modified 7-item versions: i) AD7-A: single item on planning, organization and problem solving replacing 2 items on executive function (learning how to use gadgets or appliances, and problems with judgment); and ii) AD7-B: as per AD7-A, but substituting item on disorientation to time with disorientation to place. We compared the factor structure, reliability and ROC curve-derived sensitivity, specificity and AUC between AD8 and the two modified versions. Results: Factor analysis revealed an optimal one-factor structure for all 3 versions, with degree of variance accounted for by the single factor higher in the modified versions (52%) compared with AD8 (49%). Despite being briefer than the AD8, the 7-item modified versions displayed higher reliability (Cronbach’s alpha: AD8 0.82, AD7-A 0.84, AD7-B 0.84). All 3 versions demonstrated good diagnostic performance in ECI (AD8: Sn 82.7, Sp 90.2, AUC 0.93; AD7-A: Sn 90.2, Sp 82.4, AUC 0.93; AD7-B: Sn 83.5 Sp 90.2, AUC 0.94). When analyzed by subgroups, there was no difference in diagnostic performance in early dementia (AUC ¼ 0.96 for all 3 versions); however, both modified versions
VALIDATION OF THE TURKISH VERSION OF THE ADDENBROOKE’S COGNITIVE EXAMINATION IN TURKEY
Ebru Mihci1, Hakan Gurvit2, Basar Bilgic2, Hale Alpaslan2, Ayfer Tumac2, Sinem Yildiz2, Pinar Unsalan2, Sukriye Akca Kalem2, Oget Oktem Tanor2, 1 Akdeniz University, Antalya; 2Istanbul University, Istanbul. Background: Addenbrooke’s Cognitive Examination-Revised (ACE-R) is a brief bedside cognitive screening test, which is shown to be specific and sensitive instrument not only for the diagnosis of dementia but also mild cognitive impairment (MCI). The aim of the present study was to validate the use of the Turkish version of ACE-R. Methods: We applied the adapted Turkish version of the ACE-R to 204 individuals comprising three groups: mild cognitive impairment (MCI; n ¼ 45), mild Alzheimer’s disease (AD; n ¼ 83) and healthy controls (HC; n ¼ 76). Total ACE-R score and subscores were statistically compared statistically and sensitivity, specificity, area under curve (AUC) and reliability were calculated. Results: The reliability of the ACE-R was very good (a-coefficient 0.86). Overall the mean of the total ACE-Rscore of the AD group (57.9615.3) was significantly different than the other 2 groups, but comparable between the MCI (78.668.6)and HC (82.866.9) groups. When only the highly educated (>11 years) male subgroups of the MCI and HC groups were compared the difference became significant. We found that the Turkish ACE-R at cut-off point of 73 has a sensitivity of 92% and specificity of 80% indiscriminating AD from a normal population with a perfect AUC and at 69, the test has a sensitivity of 84% and a specificity of 75% in differentiating MCI from AD with a very good AUC. The cutoff point of 88 has a sensitivity of 83% and a specificity of 100% indiscriminating male MCI patients with more than11years of education from that of healthy controls with very good AUC. Conclusions: The Turkish version of the ACE-R is a useful screening test for discriminating demented patients from non-demented individuals. Its applicability in the differentiation of MCI patients from cognitively normal elderly individuals seems to be restricted into relatively high-educated males only. These findings are largely in line with the previous non-English adaption studies of ACE-R.
P1-159
DEMENTIA AND DEPRESSION: TWO EXISTING COMORBIDITIES
Hovhannes Manvelyan, Aleksandra Karapetyan, Avetis Avetisyan, Hasmik Hambardzumyan, Astghik Karapetyan, Mikhail Aghajanov, Yerevan State Medical Univeristy, Yerevan. Background: Dementia and depression have tight interactions especially in elderly. Patients with early hallmark of dementia onset starting with Mild Cognitive Impairment (MCI) often become depressed because of the overestimation of memory deficit. Depression, or mood swings, anxiety, negative emotions and stress are another often seeing conditions in elderly. Together in clinical practice coexisting dementia and depression often could be omitted or unintentionally misdiagnosed. Thus leads to wrong diagnosis and uneffective management Methods: 51 patient (30 women and 21 man, aged 72+/8) with dementia was selected for this study, all had cognitive impairment from mild to severe and impaired activities of daily living. The inclusion criteria were positive signs in clinical investigations, low scores on dementia scales, will to cooperation and ability to understand the questions asked. All patients went through thoughtful evaluation by Folstein’s MMSE, Blessed Dementia Scale, Hamilton and Beck’s Depression Scales. Results: We found MCI in 24 patients (47%), the rest had more profound deficit. Positive signs