WITH AMNESTIC MILD COGNITIVE. IMPAIRMENT IN KOREA. Bon Ku1, Park Key Chung2, Duk Na3, 1Kwandong University Myungji. Hospital, Goyang, South ...
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Poster Presentations P3
as well as in allocentric tasks (p < .01). Conclusions: Spatial memory deficits are observed in aMCI expected to be early AD by SPECT, suggesting that spatial memory tests appear to be helpful for early detection of AD. P3-082
THE NEUROPSYCHOLOGICAL CORRELATES TO THE PROPORTIONAL IMPACT OF WHITE MATTER HYPERINTENSITIES IN THE PATIENTS WITH AMNESTIC MILD COGNITIVE IMPAIRMENT IN KOREA
Bon Ku1, Park Key Chung2, Duk Na3, 1Kwandong University Myungji Hospital, Goyang, South Korea; 2School of Medicine KyungHee University, Seoul, South Korea; 3Samsung Medical Center, Seoul, South Korea. Background: White matter hyperintensities (WMH) are frequently observed in the elderly people and have raised cognitive impairment in patients with dementia. However there has been little attention to the proportional impact of WMH to the patients with amnestic mild cognitive impairment (aMCI). We investigated the impact of WMH to the neuropsychological profiles in patients with aMCI. Methods: We recruited patients with aMCI from April 2005 to October 2010 from 41 dementia clinics across South Korea. The participants completed a comprehensive neuropsychological test, magnetic resonance imaging (MRI), and structured medical neurological and laboratory evaluations. On MRI, deep white matter (DWM) hyper intensities was classified into D1 (the longest diameter of DWM lesion < 10 mm), D2 (10mm¼DWM¼24mm), and D3 (25mm < DWM). Perventricular white matter (PWM) hyper intensities was classified into P1 (caps or rim < 5 mm), P2 (between P1 and P3), and P3 (10 mm < caps or rim). The patients were divided into three categories as minimal (D1P1, D1P2, D2P1), moderate (D1P3, D2P1, D2P2, D2P3, D3P1, D3P2) and severe (D3P3) WMH. Results: A total 1374 patients were recruited as a minimal WMH group of 1090 (79.3%), a moderate of 263 (19.1%) and severe of 21 (1.5%). Mean score of MMSE was 24.663.6 and that of CDR-SOB was 1.661.0. Advanced age was significant contributors of WMH in patients with aMCI. After adjustment of age, the neuropsychological correlates of the proportional impact of WMH were executive speed, frontal function, naming and verbal memory recognition profiles, and the most powerful correlates is the correct color reading of stroop test. Conclusions: We suggest that the neuropsychological correlates to the proportional impact of WMH is similar to that of patients with Alzheimer’s disease or sub cortical vascular dementia. P3-083
THE CLINICAL, BEHAVIORAL AND COGNITIVE CORRELATES TO THE PROPORTIONAL IMPACT OF WHITE MATTER HYPERINTENSITIES IN THE PATIENTS WITH AMNESTIC MILD COGNITIVE IMPAIRMENT IN KOREA
Bon Ku1, Park Key Chung2, Duk Na3, 1Kwandong University Myungji Hospital, Goyang, South Korea; 2School of Medicine KyungHee, Seoul, South Korea; 3School of Medicine Sungkyunkwan University, Seoul, South Korea. Background: White matter hyperintensities (WMH) are frequently observed in the elderly people and have raised cognitive impairment in patients with dementia. However there has been little attention to the proportional impact of WMH to the patients with amnestic mild cognitive impairment (aMCI). We investigated the impact of WMH to the clinical, behavioral and psychiatric profiles in patients with aMCI. Methods: We recruited patients with aMCI from April 2005 to October 2010 from 41 dementia clinics across South Korea. The participants completed a comprehensive neuropsychological test, magnetic resonance imaging (MRI), and structured medical neurological and laboratory evaluations. On MRI, deep white matter (DWM) hyperintensities was classified into D1 (the longest diameter of DWM lesion < 10 mm), D2 (10mm¼DWM¼24mm), and D3 (25mm< DWM). Perventricular white matter (PWM) hyperintensities was classified into P1 (caps or rim< 5 mm), P2 (between P1 and P3), and P3 (10 mm < caps or rim). The patients were divided into three categories as minimal (D1P1, D1P2, D2P1), moderate (D1P3, D2P1, D2P2, D2P3, D3P1, D3P2) and severe (D3P3) WMH. Results: A total 1374 patients
were recruited as a minimal WMH group of 1090 (79.3%), a moderate of 263 (19.1%) and a severe of 21 (1.5%). Mean score of MMSE was 24.663.6 and that of CDR-SOB was 1.661.0. As the WMH were increased, the portions of the owner driving and having a current job were proportionally decreased, and institutional residence, use of medication and hypertension were proportionally decreased. In the cognitive domain, language and frontal domain showed proportional impairment to the degree of WMH and multi-domain amnestic MCI was increased in proportion to WMH. In the behavioral assessment, the degree, frequency and care-giver stress of aggressive behavior was proportionally increased according to the WMH. Conclusions: In the patients with aMCI the WMH proportionally can effect negative influence to the cognition an behavior, and limit some high quality social activities. P3-084
THE COURSE OF PERSONALITY TRAITS AND THEIR ROLE IN A DEVELOPMENT OF MILD COGNITIVE IMPAIRMENT IN A PROSPECTIVE AGEING STUDY IN GERMANY
Elzbieta Kuzma1, Christine Sattler1, Pablo Toro1, Frank Oswald2, Johannes Schr€oder1, 1Department of Psychiatry, Section of Geriatric Psychiatry, Heidelberg, Germany; 2Goethe University Frankfurt, Frankfurt/Main, Germany. Background: Mild cognitive impairment (MCI) is associated with a higher risk of conversion to Alzheimer’s disease. As personality traits may have an impact on cognitive functioning, we examined premorbid personality, their course and role in a development of MCI. We expected that those who develop MCI differ from healthy controls in premorbid personality traits and that high neuroticism predicts the disease onset. Methods: The present study is based on data from the Interdisciplinary Longitudinal Study on Adult Development and Ageing (ILSE). 500 participants born between 1930 and 1932 were examined in 1993/94 (t1), 1997/98 (t2) and 2005/07 (t3). 381 participants of the original cohort were re-examined at t3. We analysed a subsample of 66 subjects who developed MCI at t2 or t3 and 156 healthy controls. Subjects were carefully screened for physical and mental health by extensive medical interviews as well as physical and neuropsychological tests. They completed the NEO-FFI questionnaire as a measure of personality traits. Results: A MANOVA with repeated measures revealed significant main effects for personality traits (F[4, 768] ¼ 326.97, p< 0.0001) and time (F[2, 384] ¼ 6.67, p¼0.001), as well as a significant interaction between diagnosis and personality traits (F[4, 768] ¼ 3.50, p¼0.007). MCI subjects scored significantly higher on neuroticism at baseline and lower on openness at all times. Subjects scoring high on neuroticism at baseline showed a 2.24 times higher risk of developing MCI at the third follow-up (OR¼2.24, 95% CI¼1.12-4.45 - scores adjusted for education and sex). Conclusions: The results support our hypothesis that MCI subjects differ in their personality traits compared to healthy controls. Premorbid high neuroticism acts as a possible risk factor for MCI development. P3-085
APOE e4 AFFECTS VISUAL MEMORY BINDING IN AMNESTIC MILD COGNITIVE IMPAIRMENT
Jan Laczo1, Ross Andel2, Kamil Vlcek3, Martin Vyhnalek1, Vaclav Mataska4, Zuzana Nedelska1, Ivana Gazova1, Ivana Mokrisova1, Hana Magerova1, Alexandra Varjassyova1, Martin Tolar5, Martin Bojar1, Jakub Hort5, 1Charles University in Prague, 2nd Medical School and University Hospital Motol and International Clinical Research Center, Brno, Prague 5, Czech Republic; 2University of Southern California, School of Aging Studies and International Clinical Research Center, Brno, Tampa, Florida, United States; 3Czech Academy of Sciences, Institute of Physiology, Prague 4, Czech Republic; 4Homolka Hospital, Prague 5, Czech Republic; 5Yale University School of Medicine, New Haven, Connecticut, United States. Background: APOE e4 (e4) carrier status is a well established risk factor for Alzheimer’s disease (AD), interfering with episodic memory and accelerating hippocampal atrophy. Therefore, we hypothesized that hippocampusspecific visual memory binding test based on the associative learning
Poster Presentations P3 paradigm can reliably differentiate amnestic mild cognitive impairment (aMCI) e4 carriers from non-carriers. Methods: Blood samples were collected to determine APOE genotype. Fifty aMCI patients were stratified into the aMCI-e4+ (n¼25) and aMCI-e4- (n¼25) groups and compared to the early-stage AD group (n¼22). We used a standard neuropsychological battery (Unified Data Set) and an experimental computer test of visual memory binding (Episodic-like MemoryTest, EMT) which required subjects to remember spatial positions and temporal orders of series of pictures in three successive levels of difficulty (with 3, 5 and 7 items). Results: The e4+ and e4- aMCI groups did not differ in basic characteristics (p’s > .27) except for gender and depression score (p’s < .01). In one-way analysis of covariance controlling for gender and depression score, we found that the aMCI e4 carriers (compared to the e4 non-carriers) had lower scores in EMT 5-item (p < .01) and 7-item (p < .05) subtests, but not in the 3-item subtest (p¼.14). The aMCI e4 carriers were similar to the AD group in all EMT subtests (p’s > .48). There were no differences between e4 carriers and non-carriers in other neuropsychological tests (p’s > .15). Conclusions: We found a more profound visual memory binding deficit in aMCI e4 carriers than non-carriers. The deficit in e4 carriers resembled that found in the early-stage AD group. Memory binding represent a promising area with respect to identifying individuals at higher risk for AD in the heterogeneous MCI population. P3-086
PERFORMANCE-BASED AND SELF-RATED EVERYDAY FUNCTIONING IN PERSONS WITH MILD COGNITIVE IMPAIRMENT
Feng Lin1, Rachel Roiland1, Shelly Vandenbergh2, Dorothy Edwards1, Carey Gleason1, Susan Heidrich1, 1University of Wisconsin-Madison, Madison, Wisconsin, United States; 2University of Wisconsin Hospital and Clinics, Madison, Wisconsin, United States. Background: Persons with Mild Cognitive Impairment (PWMCI) have more difficulties than their healthy counterparts in performance-based everyday functioning involving cognitive abilities and report lower levels of self-rated everyday functioning. Improving or maintaining high levels of performance-based and self-rated everyday functioning are important for maintaining quality of life for PWMCI. However, it is unclear if performance-based and self-rated everyday functioning measures tap the same construct. The purpose of this descriptive study was to 1) describe performance-based and self-rated everyday functioning in PWMCI, 2) examine the relationship between performance-based and self-rated everyday functioning, and 3) explore the predictors (demographic information, health history, and dementia related self-care behaviors) of performance-based and self-rated everyday functioning. Methods: Sixty three PWMCI (age range ¼ 60 - 93; Montreal Cognitive Assessment scores range ¼ 9 - 28) completed the Timed Instrumental Activities of Daily Living (TIADL) assessment, including five performance-based everyday functioning tasks. Self-rated everyday functioning was measured using the Medical Outcomes Study SF-12 Physical Component Summary Score (PCS). Dementia related selfcare behaviors were measured with three checklists: dementia prevention behaviors, use of memory aids, and use of services. Results: Subjects’ completion time for the five TIADL tasks (range ¼ 20.4 - 84.2 seconds) was longer than that of a healthy comparison sample (range ¼ 17.0 72.3 seconds) (the ACTIVE study, 2002). Subject’s self-rated everyday functioning was lower than population norms for PCS (Ware et al., 1994). Partial correlation between TIADL and PCS, controlling for depression, co-morbidity, and years of education, was not significant. Predictors of everyday functioning differed by type of measure, however. Significant predictors of TIADL were age (ß ¼ 0.31), depression (ß ¼ 0.22), global cognition (ß ¼ -0.29), dementia prevention behaviors (ß ¼ 0.23), and use of memory aids (ß ¼ -0.42) (adjusted R2 ¼ 0.55, F ¼ 8.79, p < 0.001). Significant predictors of PCS were depression (ß ¼ -0.25) and use of services (ß ¼ -0.38) (adjusted R2 ¼ 0.30, F ¼ 3.80, p ¼0.001). Conclusions: Performance-based and self-rated everyday functioning measures were influenced by different sets of factors. Interventions aimed at improving PWMCI everyday functioning need examine all of the factors that may be influencing everyday functioning.
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S541 PREMCI, EMCI AND AMCI: COMPARISON OF IMAGING FEATURES, APOE FREQUENCIES AND PROGRESSION RATES TO DEMENTIA
David Loewenstein1, Maria Greig-Custo2, Elizabeth Potter2, Warren Barker2, Balaibail Raj3, John Schinka3, Michael Schoenberg3, Jessica Banko3, Huntington Potter3, Ranjan Duara2, 1University of Miami, Miami, Florida, United States; 2Mount Sinai Medical, Miami Beach, Florida, United States; 3University South Florida, Tampa, Florida, United States. Background: Identification of an early predementia stage of Alzheimer’s disease as a basis for intervention at a stage when treatment is likely to be most successful, requires definition of a discrete cognitive syndrome that is earlier than MCI, which can be diagnosed reliably. Methods: At baseline, subjects were diagnosed with no cognitive impairment (NCI) (n¼216), PreMCI (n¼125), early MCI (eMCI) (n¼90), non-amnestic MCI (naMCI) (n¼26), or late MCI (LCMI) (n¼30) using the following criteria: (1) PreMCI ¼ CDR score of 0.5, logical memory-delayed (LM-D) test score within 0.5 SD of age and education adjusted means (AEAMs), and all non-amnestic tests within 1.5 SD of AEAMs; (2) eMCI ¼ CDR score of 0.5, MMSE of > 24, LM-D score between 0.5 and 1.5 SD of EAMs; (3) naMCI ¼ CDR score of 0.5, MMSE of > 24, LM-D score within 0.5 SD of AEAMs, and one or more non-amnestic measures at > 1.5 SD below AEAMs; (4) LMCI ¼ CDR score of 0.5, MMSE of > 24, LM-D score > 1.5 SD below AEAMs. APOE allele frequencies, medial temporal atrophy (MTA) scores based on visual ratings of brain MRIs, and progression rates to dementia (on 2-3 year follow-up) were assessed for each subject group. Results: ApoE4 frequencies were not different between groups, although differences in MTA scores were found, i.e., 31% of LMCI, 23% of eMCI, 23% of PreMCI, 4.5% of naMCI, and 9.4% of NCI subjects scored above the threshold (defined as 1.50) (range 0 to 4) [X2 (df¼4)¼16.88; p < .003]. Differences in rates of progression to dementia were also present, i.e., 23.1% for CDR 0.5 alone; 28% for PreMCI, 34.0% for eMCI, and 43.8% for LMCI [X2 (df ¼ 4)¼44.52; p < .001]. Subjects with naMCI or NCI subjects did not progress to dementia. Conclusions: PreMCI and eMCI (but not naMCI) subjects have greater MTA scores and progression rates to dementia than NCI subjects, and are therefore appropriate targets for very early intervention clinical trials. Although the diagnosis of PreMCI is more labour-intensive requiring additional non-amnestic tests, it is likely to be a better-defined and less heterogeneous entity. In the absence of any deficit in LM-D scores, naMCI appears to be a variant of normal cognition. P3-088
VAGUS SOMATOSENSORY-EVOKED POTENTIALS: A NON-INVASIVE DIAGNOSTIC POSSIBILITY FOR PATIENTS WITH MILD COGNITIVE IMPAIRMENT?
Florian Metzger1, Thomas Polak2, Katja Hagen3, Ann-Christine Ehlis3, 1 Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany; 2University of Wuerzburg, Wuerzburg, Germany; 3University of Tuebingen, Tuebingen, Germany. Background: Alzheimer’s Dementia (AD) affects widespread areas in all parts of the brain. AD-typical alterations could be revealed in brainstem by neuropathological methods, also in the Nuclei of the N. vagus. It is not known, whether these changes can also be observed in the state of mild cognitive impairment (MCI). Only a few diagnostic procedures considered the function of brainstem in AD. Vagus-somatosensory evoked potentials (VSEP) are far-field potentials from the brainstem and could be a representation of the function of the brainstem. Furthermore, the measurement is simply applicable for psychiatric patients. Methods: 13 patients with AD, 12 with MCI and 27 age- and gender-matched healthy controls were investigated by stimulating the cutane branch of the N. vagus at the inner side of the tragus of the right ear with an electrical square impulse of 0.1 msec duration. The response was bipolarly recorded from the electrode positions C3-F3, C4-F4, Fz-F3 and Fz-F4 of the international 10-20-system. After averaging, the VSEP could be defined by the first maximum (P1), the following minimum (N1) and the second maximum (P2). Results: In the electrode
