- Email: [email protected]
WALKING PERFORMANCE PREDICTS COGNITIVE IMPAIRMENT IN ELDERLY ISCHEMIC STROKE PATIENTS: A RETROSPECTIVE ANALYSIS
Poster Presentations: P3 P3-158
WALKING PERFORMANCE PREDICTS COGNITIVE IMPAIRMENT IN ELDERLY ISCHEMIC STROKE PATIENTS: A RETROSPECTIVE ANALYSIS
Eliyahu Hayim Mizrahi1, Abraham Adunsky2, 1The Geriatric and Rehabilitation Center "Shmuel-Harofe", Beer-Yaakov, Israel; 2Sheba Medical Center, Ramat-Gan, Israel. Contact e-mail: dmizrahi49@gmail. com Background: Stroke is a leading cause of morbidity and is associated with motor and cognitive dysfunction. The aim of the study is toinvestigate whether, and to what extent, post-stroke walking performance at admission to a rehabilitation ward is associated with cognitive impairment. Methods: A retrospective study comprising 653 consecutive elderly ischemic stroke patients. Level of walking performance (WP) was determined by Functional Independence Measurement (FIMTM) sub-scale scores relevant to walking performance, where scores 5 points define low-walking performance (Low-WP) ability and scores >5 indicate high-walking performance (High-WP). Cognitive status was assessed by the Mini-Mental State Examination (MMSE), and scores lower than 24 points were considered as suggestive of cognitive impairment. Data was analyzed by t test, Chi-square test, multiple linear regression and logistic regression. Results: Age, gender, diabetes, atrial fibrillation and dementia emerged as the only statistically significant parameters differing between those with and without Low-WP. After adjustment for confounding variables, low-WP (odds ratio 2.86, 95% CI 1.01-8.1, p¼0.047) was associated with an increased risk of cognitive impairment. Conclusions: Lower walking performance in older ischemic stroke patients is significantly associated with cognitive decline. Table 1 Summary of logistic regression analysis for variables predicting cognitive impairment (MMSE<24). Variables
b
O.R.
C.I.
P
Walking performance Age Gender(female) Ischemc heart disease Arterial hypertension Diabetes mellitus Atrial - fibriallation Dementia Parkinson’s disease Previous - stroke
1.053 -0.023 0.406 -0.364 -0.107 0.261 0.313 2.335 -0.221 0.372
2.867 0.97 1.501 0.695 0.899 1.298 1.368 10.327 0.802 1.45
1.014-8.107 0.956-0.999 1.056-2.132 0.482-1.001 0.618-1.308 0.912-1.847 0.873-2.144 4.937-24.533 0.316-2.037 0.959-2.194
0.047 0.039 0.024 0.051 0.578 0.147 0.172 <0001 0.643 0.078
P3-159
EXECUTIVE DYSFUNCTION IN PREVALENT VERSUS INCIDENT AMNESTIC MILD COGNITIVE IMPAIRMENT
Gretchen Schlosser Covell1, Richard J. Caselli2, 1Mayo Clinic Arizona Neurology, Scottsdale, Arizona, United States; 2Mayo Clinic, Scottsdale, Arizona, United States. Contact e-mail: [email protected] Background: Alzheimer’s disease (AD) begins decades before clinically symptomatic memory loss (mild cognitive impairment [MCI]) which longitudinal studies have shown represents the earliest cognitive domain of decline. Clinical series however suggest that executive skills also decline during the MCI stage. We therefore asked whether patients with amnestic
P687
MCI seeking medical attention (prevalent MCI) have greater executive dysfunction than patients with incident MCI identified in longitudinal research cohorts of cognitive aging. Methods: Methods: Neuropsychological test scores of 39 patients with prevalent MCI and 39 with incident MCI who did not differ in age, education, or gender were compared using unpaired t-tests. All patients met published criteria for Amnestic MCI (J Intern Med. 2004 Sep; 256(3) 183-94). Results: The participants did not differ by age (75.5[8.8] vs 72.8 [7.3], p¼0.16), education (15.0 [2.8] vs 16.1 [2.5], p¼0.09) or gender (43% vs 51% women, p¼0.57). Both groups met criteria for MCI based on a neuropsychological testing battery and clinical evaluation. There were no differences on memory scores on the Auditory Verbal Learning Test Total Learning (28.8 [8.6] vs. 32.5[9.2], p¼0.067), short term delayed recall (3.4 [2.6] vs. 4.4 [2.9], p¼0.072), or long term delayed recall (1.97 [2.2] vs 2.46 [2.8], p¼ 0.31). Prevalent cases performed less well on tests sensitive to executive skills including the WAIS-digit span (8.67 vs 11.28 p¼0.0006), WAIS-similarities (9.66 vs 12.02 p¼ 0.0002), verbal fluency (29.66 vs 42.54 p<0.001), Trail Making Test B (168.7 vs 105.9 p¼0.001), and the Wisconsin Card Sorting Testperseverative errors (42.25 vs 25.78 p¼0.0063). Prevalent cases also performed less well on WAIS-Vocabulary (10.18 vs 11.76 p¼0.01) and the Token test (39.38 vs 42.24 p¼0.004). Conclusions: By the time patients seek clinical evaluation for memory loss, they have a more advanced stage of MCI than incidentally captured MCI converters. Although MCI is regarded as the earliest clinical stage of AD, it represents a spectrum of severity. Incident MCI is characterized primarily by memory impairment, but additional domains, particularly executive skills, are declining by the time patients seek medical attention, although the level of decline is generally insufficient to be characterized as clinically abnormal. P3-160
EMPIRICALLY DEFINING TRAJECTORIES OF LATE-LIFE COGNITIVE AND FUNCTIONAL DECLINE
Helen Hochstetler1, Shufang Wang1, Peng Yu1, Paula T. Trzepacz1, Michael Case1, David Henley1, Elisabeth Degenhardt1, JeannieMarie Sheppard Leoutsakos2, Constantine Lyketsos3, 1Eli Lilly and Company, Indianapolis, Indiana, United States; 2Johns Hopkins School of Medicine, Ellicott City, Maryland, United States; 3Johns Hopkins University, Baltimore, Maryland, United States. Contact e-mail: [email protected] Background: The objective was to define trajectories of cognitive and functional decline, and characteristics associated with distinct trajectories, using Growth Mixture Modeling (GMM). Methods: We studies healthy controls (HC, n¼325), and persons with early mild cognitive impairments (EMCI, n¼279), late MCI (LMCI, n¼372), or Alzheimer’s disease (AD) dementia (n¼216) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI-1, GO and 2). We focused on participants with available baseline beta-amyloid measurements who were assessed on the Alzheimer’s Disease Assessment Scale-cognitive (ADAS-Cog 14) and Functional Activities Questionnaire (FAQ) for up to 24 months. Cerebrospinal fluid (CSF) Ab 1-42, or composite SUVR for [11 C]PiB or [18 F]florbetapir PET, determined amyloid status and the time of baseline for our analyses. GMM was conducted on ADAS-Cog and FAQ. Subsequently, baseline variables for each class were compared including diagnosis, demograpics, co-morbidities, clinical and cognitive measures, and APOE allele status. Results: We identified 3 trajectories of cognitive and functional change (Table): Class 1 (n¼162, 13.6%) "moderately progressive" with highest baseline scores on FAQ
Table 1 Mean FAQ and ADAS-Cog13 Scores over Time by Latent Class FAQ
ADAS-Cog
Class
Time¼0
6 Months
12 Months
24 Months
Time¼0
6 Months
12 Months
24 Months
Class 1 Class 2 Class 3
16.0 6.5 1.2
19.5 8.4 1.1
22.1 10.5 1.2
24.8 15.3 1.8
30.0 23.1 12.6
33.7 24.5 12.2
37.3 25.9 12.2
44.0 28.6 13.0
WALKING PERFORMANCE PREDICTS COGNITIVE IMPAIRMENT IN ELDERLY ISCHEMIC STROKE PATIENTS: A RETROSPECTIVE ANALYSIS
Eliyahu Hayim Mizrahi1, Abraham Adunsky2, 1The Geriatric and Rehabilitation Center "Shmuel-Harofe", Beer-Yaakov, Israel; 2Sheba Medical Center, Ramat-Gan, Israel. Contact e-mail: dmizrahi49@gmail. com Background: Stroke is a leading cause of morbidity and is associated with motor and cognitive dysfunction. The aim of the study is toinvestigate whether, and to what extent, post-stroke walking performance at admission to a rehabilitation ward is associated with cognitive impairment. Methods: A retrospective study comprising 653 consecutive elderly ischemic stroke patients. Level of walking performance (WP) was determined by Functional Independence Measurement (FIMTM) sub-scale scores relevant to walking performance, where scores 5 points define low-walking performance (Low-WP) ability and scores >5 indicate high-walking performance (High-WP). Cognitive status was assessed by the Mini-Mental State Examination (MMSE), and scores lower than 24 points were considered as suggestive of cognitive impairment. Data was analyzed by t test, Chi-square test, multiple linear regression and logistic regression. Results: Age, gender, diabetes, atrial fibrillation and dementia emerged as the only statistically significant parameters differing between those with and without Low-WP. After adjustment for confounding variables, low-WP (odds ratio 2.86, 95% CI 1.01-8.1, p¼0.047) was associated with an increased risk of cognitive impairment. Conclusions: Lower walking performance in older ischemic stroke patients is significantly associated with cognitive decline. Table 1 Summary of logistic regression analysis for variables predicting cognitive impairment (MMSE<24). Variables
b
O.R.
C.I.
P
Walking performance Age Gender(female) Ischemc heart disease Arterial hypertension Diabetes mellitus Atrial - fibriallation Dementia Parkinson’s disease Previous - stroke
1.053 -0.023 0.406 -0.364 -0.107 0.261 0.313 2.335 -0.221 0.372
2.867 0.97 1.501 0.695 0.899 1.298 1.368 10.327 0.802 1.45
1.014-8.107 0.956-0.999 1.056-2.132 0.482-1.001 0.618-1.308 0.912-1.847 0.873-2.144 4.937-24.533 0.316-2.037 0.959-2.194
0.047 0.039 0.024 0.051 0.578 0.147 0.172 <0001 0.643 0.078
P3-159
EXECUTIVE DYSFUNCTION IN PREVALENT VERSUS INCIDENT AMNESTIC MILD COGNITIVE IMPAIRMENT
Gretchen Schlosser Covell1, Richard J. Caselli2, 1Mayo Clinic Arizona Neurology, Scottsdale, Arizona, United States; 2Mayo Clinic, Scottsdale, Arizona, United States. Contact e-mail: [email protected] Background: Alzheimer’s disease (AD) begins decades before clinically symptomatic memory loss (mild cognitive impairment [MCI]) which longitudinal studies have shown represents the earliest cognitive domain of decline. Clinical series however suggest that executive skills also decline during the MCI stage. We therefore asked whether patients with amnestic
P687
MCI seeking medical attention (prevalent MCI) have greater executive dysfunction than patients with incident MCI identified in longitudinal research cohorts of cognitive aging. Methods: Methods: Neuropsychological test scores of 39 patients with prevalent MCI and 39 with incident MCI who did not differ in age, education, or gender were compared using unpaired t-tests. All patients met published criteria for Amnestic MCI (J Intern Med. 2004 Sep; 256(3) 183-94). Results: The participants did not differ by age (75.5[8.8] vs 72.8 [7.3], p¼0.16), education (15.0 [2.8] vs 16.1 [2.5], p¼0.09) or gender (43% vs 51% women, p¼0.57). Both groups met criteria for MCI based on a neuropsychological testing battery and clinical evaluation. There were no differences on memory scores on the Auditory Verbal Learning Test Total Learning (28.8 [8.6] vs. 32.5[9.2], p¼0.067), short term delayed recall (3.4 [2.6] vs. 4.4 [2.9], p¼0.072), or long term delayed recall (1.97 [2.2] vs 2.46 [2.8], p¼ 0.31). Prevalent cases performed less well on tests sensitive to executive skills including the WAIS-digit span (8.67 vs 11.28 p¼0.0006), WAIS-similarities (9.66 vs 12.02 p¼ 0.0002), verbal fluency (29.66 vs 42.54 p<0.001), Trail Making Test B (168.7 vs 105.9 p¼0.001), and the Wisconsin Card Sorting Testperseverative errors (42.25 vs 25.78 p¼0.0063). Prevalent cases also performed less well on WAIS-Vocabulary (10.18 vs 11.76 p¼0.01) and the Token test (39.38 vs 42.24 p¼0.004). Conclusions: By the time patients seek clinical evaluation for memory loss, they have a more advanced stage of MCI than incidentally captured MCI converters. Although MCI is regarded as the earliest clinical stage of AD, it represents a spectrum of severity. Incident MCI is characterized primarily by memory impairment, but additional domains, particularly executive skills, are declining by the time patients seek medical attention, although the level of decline is generally insufficient to be characterized as clinically abnormal. P3-160
EMPIRICALLY DEFINING TRAJECTORIES OF LATE-LIFE COGNITIVE AND FUNCTIONAL DECLINE
Helen Hochstetler1, Shufang Wang1, Peng Yu1, Paula T. Trzepacz1, Michael Case1, David Henley1, Elisabeth Degenhardt1, JeannieMarie Sheppard Leoutsakos2, Constantine Lyketsos3, 1Eli Lilly and Company, Indianapolis, Indiana, United States; 2Johns Hopkins School of Medicine, Ellicott City, Maryland, United States; 3Johns Hopkins University, Baltimore, Maryland, United States. Contact e-mail: [email protected] Background: The objective was to define trajectories of cognitive and functional decline, and characteristics associated with distinct trajectories, using Growth Mixture Modeling (GMM). Methods: We studies healthy controls (HC, n¼325), and persons with early mild cognitive impairments (EMCI, n¼279), late MCI (LMCI, n¼372), or Alzheimer’s disease (AD) dementia (n¼216) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI-1, GO and 2). We focused on participants with available baseline beta-amyloid measurements who were assessed on the Alzheimer’s Disease Assessment Scale-cognitive (ADAS-Cog 14) and Functional Activities Questionnaire (FAQ) for up to 24 months. Cerebrospinal fluid (CSF) Ab 1-42, or composite SUVR for [11 C]PiB or [18 F]florbetapir PET, determined amyloid status and the time of baseline for our analyses. GMM was conducted on ADAS-Cog and FAQ. Subsequently, baseline variables for each class were compared including diagnosis, demograpics, co-morbidities, clinical and cognitive measures, and APOE allele status. Results: We identified 3 trajectories of cognitive and functional change (Table): Class 1 (n¼162, 13.6%) "moderately progressive" with highest baseline scores on FAQ
Table 1 Mean FAQ and ADAS-Cog13 Scores over Time by Latent Class FAQ
ADAS-Cog
Class
Time¼0
6 Months
12 Months
24 Months
Time¼0
6 Months
12 Months
24 Months
Class 1 Class 2 Class 3
16.0 6.5 1.2
19.5 8.4 1.1
22.1 10.5 1.2
24.8 15.3 1.8
30.0 23.1 12.6
33.7 24.5 12.2
37.3 25.9 12.2
44.0 28.6 13.0