ahmed2016 (1)

1. Poster Presentations: Monday, July 25, 2016 P703 Background:The aim of this study was to evaluate the Clinical Dementia Rating Scale sum of the boxes (CDR-SB) diagnostic validity in detecting and staging cognitive impairment/dementia in a sample of Brazilian patients with amnestic mild cognitive impairment, Alzheimer’s disease, and vascular dementia of lower educational attainment. Methods: Data were obtained from the Dementia Clinic of Hospital de Cl? ınicas de Porto Alegre data- base and included 407 participants (115 healthy elderly, 41 aMCI, 165 AD, and 86 VD). Receiver operating characteristic curves were generated to detect best CDR-SB cutoffs. Average education was 4 years. Results:A CDR-SB cutoff ?0.5 was ob- tained to correctly identify MCI from normal controls (sensitivity of 100% and specificity of 98.3%). The cutoff?4.5 correctly iden- tified aMCI from dementia patients altogether or separately (AD and VD) (sensitivity of 96.4% and specificity of 100%) whereby correct classification was 96.9%. Conclusions: The CDR-SB showed good clinical validity to detect and classify severity of cognitive impairment in low educational attainment Brazilian population. Findings were similar to the original study carried out with higher educated participants. Change in the initial diagnosis after the tests and follow up. Frequencies Absolute Relative No Yes Total 320 109 432 74,1 25,2 100,0 have limited benefit and should be weighted to improve clinical accuracy. P2-214 THE INFLUENCE OF THE HEALTH CONDITION OF THE CAREGIVER: THE CARE ENVIRONMENT AND THE PROGNOSIS OF PATIENTS WITH ALZHEIMER’S DISEASE Miyuki Matsumura, Institute of Geriatrics Tokyo Women’s Medical University, Tokyo, Japan. Contact e-mail: mmatsu@aqua.ocn.ne.jp Background:The caregiver has a strong influence on the quality of dementia care; therefore, healthcare professionals acknowledge the importance of providing mental support to caregivers. I examined that the influence of the caregiver’s health on the prognosis of the dementia patient. Methods: Subjects were 23 patients with AD, with a Clinical Dementia Rating (CDR) of 3. Further, 12 of these patients lived at home (HL group) and 11 of them lived at a nursing home (NH group). The participants’ age, years of education and disease period corresponded between the two groups. I evaluated the patients’ functions using MMSE, MENFIS, DAD, Digit Span Test and Trail Making Test. I compared the two groups in terms ofnumberofcaregivers,sex,andwhethertheyusedthedayservice. In the NH group, I also examined the reason for admission into the nursing home. Results:Six patients with AD were admitted to the nursing home because their caregiver died or fell sick; the other five entered the nursing home because of caregiver burden. Two of the participants died about six months after admission into the nursing home. The average number of caregivers was less than oneintheNHgroup,andtwoormoreintheHLgroup.Dayservices were utilized more in the NH group (n ¼ 8) than the HL group (n ¼ 1). The mean MENFIS score of the HL group was 261, which was significantly lower than that of the NH group 362. Conclusions: This study revealed that more than half of the AD patients entered the nursing home because of the illness or death of their caregivers. Thisindicates that it is extremely important to manage the health of the caregivers in order to ensure that patients with AD live at home for long. Doctors, nurses, and other healthcare staff should also focus on the health of the caregiver during the course of treatment of dementia. P2-216 TRAUMATIC BRAIN INJURY (TBI) AND DEMENTIA PROGRESSION Mohammed Muzammil Ahmed1,2,3, Lilah M. Besser4, DouglasR. Galasko5,6, DavidP.Salmon6,7, WalterA. Kukull4,8,1University of California, San Diego, San Diego, CA, USA;2Shiley-Marcos Alzheimer’s Disease Research Center, LA, CA, USA;3Hoag Neuroscience Institute, Newport Beach, CA, USA;4University of Washington, Seattle, WA, USA; 5University of California, San Diego, La Jolla, CA, USA;6Shiley-Marcos Alzheimer’s Disease Research Center, La Jolla, CA, USA;7UC San Diego, La Jolla, CA, USA;8National Alzheimer’s Coordinating Center, Seattle, WA, USA. Contact e-mail: m9ahmed@ucsd.edu Background:Traumatic Brain Injury (TBI) has been identified as a risk factor for the development of dementia, not specifically due to Alzheimer’s pathology. There is very limited data about the progression of dementia after TBI. The primary objective of the study was to assess, among individuals with Alzheimer’s disease neuropathology (ADNP) and dementia, if those who recently suffered from a TBI had a faster clinical progression than those with no TBI history. Methods:We used data on partic- ipants with ADNP in the National Alzheimer’s Coordinating Center’s (NACC) Uniform Data Set and Neuropathology Data Set. ANDP was defined as having moderate/frequent neuritic plaques and Braak stages III-VI for neurofibrillary degeneration. The sample consisted of 55 participants with TBI, and 1509 sub- jects with no reported TBI history as reported in NACC dataset. We described the demographic, clinical, and TBI characteristics, and used multivariable linear mixed models to compare the clin- ical progression among those with and without TBI. Clinical progression was measured using annual change in the Clinical Dementia Rating Sum of Boxes (CDR-SB) score. Results:Partic- ipants with a recent TBI were more often male and completed fewer visits. Brief loss of consciousness (LOC) was reported in 64%, extended LOC was reported in 29%, and chronic deficit was reported in 24% of those with a recent TBI. After adjusting for age, sex, education, Lewy body pathology, and vascular pa- thology, those with recent TBI experienced a faster clinical decline than those without TBI (p<.0001). Additionally, the P2-215 USE OF THE CLINICAL DEMENTIA RATING SCALE SUM OF BOXES SCORES IN DETECTING AND STAGING COGNITIVE IMPAIRMENT/ DEMENTIA IN LOW EDUCATIONAL ATTAINMENT BRAZILIAN PATIENTS Andrea Lima1, Claudia Godinho2, Analuiza Camozzato3, Marcia L. Chaves11Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil;2Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; 3UFCSPA, Porto Alegre, Brazil. Contact e-mail: mchaveshcpa@gmail.com

2. P704 Poster Presentations: Monday, July 25, 2016 Table 1 Association between recent TBI and annual change in Clinicai Dementia Raring Sum of Boxes Adjusted model 1a Adjusted model 2b Unadjusted model Variable beta estimate (95% CI) p-value beta estimate (95% CI) p-value beta estimate (95% CI) p-value Time (years) TBI historyb TBI history *time 1.30 (0.08) 0.58 (0.60) -0.53 (0.23) <.0001 0.33 0.02 1.65 (0.08) 1.05 (0 56) -0.62 (0.20) <0001 2.02 (0.06) 0.09 (0.09) -0.15 (0.26) <.000l 0.31 0.57 0.06 0.002 Abbrevations: N/A ¼ not applicable aAdjusting for age at baseline, sex, education, presence of LB disease pathology, presence of vascular pathology b Model 1 plus additionally adjusting for CDR-SB at the first UDS visit reporting a recent TBI. bTBI history (l¼present, 0¼not present) CDR-SB score at baseline was borderline statistically signifi- cantly worse for those with recent TBI than those without (p¼0.06). Conclusions: TBI may cause faster progression of dementia. comparison, and logistic regression were performed. Results: A total of 92 subjects were diagnosed having MCI at first visit. Twenty one (22.8%) were lost in follow-up. There was no statis- tical difference between the defaulted and follow-up groups with regard to HK-MoCA score and demographics. The age and HK- MoCA score (mean/standard deviation) of 71 subjects with follow-up data available was 76.24/8.2 years and 16.85/4.8 respectively. One was dead within a year. Of the remaining 70 patients, 30.0% and 44.3% was converted to dementia at first and second year respectively. There was no statistical signifi- cance in age, education and gender between the converter and non-converter groups. However, score of HK-MoCA was signif- icantly lower in the converter group (14.94/5.07 vs 18.73/3.91, p¼0.001) and the conversion rates were different among MCI subtypes (Table 1). Logistic regression however confirmed the HK-MoCA score was the only variable to predict conversion (Exp(B) ¼ 0.809, p¼0.001). The conversion rates were higher with the subjects scoring lower than cut-off scores for MCI and dementia at 1stand 2ndyear follow-up (Figure 1 & 2). How- ever, the difference in conversion rates was statistically signifi- cant with dementia cutoff score of 18/19 (Odd ratio¼2.88; CI¼ 1.05-7.89; p¼0.033) but not with MCI score of 21/22 (Odd ratio¼1.86; CI¼0.51-6.90; p¼0.066). Conclusions: HK- MoCA is a sensitive to detect MCI. Individuals with MCI with low HK-MoCA score below dementia cut-off are at greater risk of short-term conversion to dementia. P2-217 A STUDY OF THE HONG KONG VERSION OF THE MONTREAL COGNITIVE ASSESSMENT (HK- MOCA) AS A PREDICTOR OF CONVERSION FROM MILD COGNITIVE IMPAIRMENT TO DEMENTIA Tang Lap Nin1, Mei Ling Lau1, Chun Chung Chan1, Yuen Yee Tam1, Cho Yiu Yung1, Hiu Sze Li1, Pui Yu Yeung2,1United Christian Hospital, Hong Kong, Hong Kong;2Kowloon Hospital, HK, Hong Kong. Contact e-mail: tangln1@ha.org.hk Background: The HK-MoCA is a brief and feasible cognitive screening instrument for use in Chinese older adults in Hong Kong clinical setting. It has been validated that it is much sensi- tive to detect mild cognitive impairment (MCI) compared with the Cantonese version of Mini-Mental State Examination (C- MMSE). However, its use in monitoring the disease progression is largely unknown. Methods:A total of 275 subjects aged over 60 were referred to a public hospital based cognitive clinic for suspected cognitive impairment from 12/2011 to 5/2013. Referred cases were assessed using HK-MoCA on first visit, baseline demographic data were collected, and subtypes of MCI were diagnosed by experienced geriatricians according to DSM-IV criteria. All subjects were followed in the clinic for 2 years. Statistical analysis including descriptive, between groups Figure 1. Figure 2.