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Poster Presentations: P4P768
Participants underwent Mini Mental Status Exam (MMSE), and 2 hour oral
glucose tolerance test (OGTT) after an overnight fast. The Homeostasis
Model Assessment (HOMA) index of insulin resistance was calculated. A
subset (47%) also had fasting plasma Ab42 measurements. Outcomes
were analyzed by Pearson correlation and analysis of covariance with age
and BMI as covariates. Results: Two hour glucose positively correlated
with age (+0.18, p<0.01) and Ab42 (+0.29, p<0.01), and inversely corre-
lated with MMSE (-0.17, p<0.05). Individuals with 2h glucose >140 had
higher Ab42 levels than those <140 (p<0.01). Adults with MCI or AD
had higher HOMA-IR values than adults with normal cognition (3.8 60.13 vs 3.2 6-0.19, p<0.01), but lower 2h glucoses (143 6 3 vs 157 6 4,
p<0.01), possibly due to overrepresentation of impaired glucose tolerance
in the normal group. Men had higher HOMA-IR values than women (3.8
6 0.16 vs 3.2 6 0.17, p¼0.01) but lower 2h glucoses (138 6 3 vs 157 64, p<0.001), and E4+ men had lower 2h glucoses than E4- men (p<0.01)
despite similar levels of 2h insulin. Conclusions: In older adults with im-
paired glucose tolerance, 2h glucose correlated with lower MMSE and
higher plasma Ab42, and adults with cognitive impairment had higher
HOMA-IR indices than those with normal cognition. These findings
support a link between glucose metabolism and AD. Furthermore, APOE
genotype and gender influence glucose metabolism, which suggests
a need to consider these factors in studies of AD therapeutics involving glu-
cose and insulin.
P4-168 AGGREGATION OF VASCULAR RISK FACTORS
AGGRAVATES NEUROPSYCHOLOGICAL
PERFORMANCE IN MILD COGNITIVE
IMPAIRMENT (MCI) INDEPENDENTLY OF
STROKE DISEASE
Laura Tay1, Mei Sian Chong1, Peng ChewMark Chan1, Wee Shiong Lim1,1Tan Tock Seng Hospital, Singapore, Singapore. Contact e-mail:
Background: Vascular risk factors have been implicated in cognitive de-
cline and risk of subsequent dementia in MCI. The exact pathophysiological
mechanisms remain to be fully elucidated. In this study, we evaluated the
influence of aggregation of vascular risk factors, independent of stroke dis-
ease, on neuropsychological performance and risk of dementia conversion
in patients with MCI.Methods: This is a longitudinal study of 42 MCI pa-
tients without prior history of stroke or transient ischemic attack. Patients
were stratified into 3 groups based on presence of cerebral infarcts on neuro-
imaging and vascular risk factor score: (i) MCI-infarct group with evident
cerebral infarcts on neuroimaging (n¼15), (ii) MCI-VRF+ group with no
cerebral infarcts but with 2 to 4 vascular risk factors (n¼14), (iii) MCI-
VRF- group with no cerebral infarcts and 0 to 1 vascular risk factor
(n¼13). Vascular risk factors included were hypertension, dyslipidaemia,
diabetes mellitus and ischemic heart disease. Severity of white matter le-
sions was graded in all patients using age-related white matter changes rat-
ing scale (ARWMC). We compared neuropsychological test performance at
baseline between the three groups and followed for dementia conversion at 1
year. Results: MCI-VRF+ had the highest number of vascular risk factors,
followed by MCI-infarct and MCI-VRF- (mean: 2.71, 1.27, 0.31 respec-
tively, p<0.001). MCI-VRF+ was significantly more impaired in confronta-
tional naming than MCI-VRF- and MCI-infarct (z scores -1.17, 0.19, -0.56
respectively, p¼0.04). In addition, MCI-VRF+ displayed a trend for greatest
impairment in visuo-spatial and executive performance, as well as in all am-
nestic domains. 4 patients (9.5%) converted to dementia at 1 year, with
a trend towards increased risk for conversion in MCI-VRF+ (n¼2, 14.3%)
compared with MCI-VRF- (n¼1, 7.7%) and MCI-infarct (n¼1, 6.7%).
White matter lesion burden increased incrementally across MCI-VRF-,
MCI-infarct and MC-VRF+ groups (global ARWMC score 4.23, 5.40,
6.50, p¼0.27). Conclusions: Aggregation of vascular risk factors, indepen-
dent of cerebral infarcts, aggravates impairment in neuropsychological per-
formance in MCI, with potentially increased risk of subsequent dementia.
Our results suggest that control of vascular risk factors may be important
in patients with MCI.
P4-169 VALIDATION OF THE HEALTHY BRAIN
CHECKLIST SCREENING QUESTIONNAIRE IN
A COMMUNITY SETTING
William Shankle1, Celine Keeble1, Denise Macias1, Dennis Fortier2,
Junko Hara3, Dori Holnagel1, Michael Brant-Zawadzki1, Julie Russell4,
Nichole Guillen Nguyen5, 1Hoag Neurosciences Institute, Newport Beach,
California, United States; 2Medical Care Corporation, Newport Beach,
California, United States; 3Shankle Clinic, Newport Beach, California,
United States; 4Pepperdine University, Los Angeles, California, United
States; 5HoagMemorial Hospital Presbyterian, Newport Beach, California,
United States. Contact e-mail: [email protected]
Background: The Healthy Brain Checklist (HBC) is a 16-item, self-admin-
istered screening questionnaire that assesses cognitively related functional
abilities, cognitive change, and depression. The HBC takes a few minutes,
does not require physician or staff time, and is suitable for the annual Medi-
care wellness visit in routine clinical practice settings. The HBC was de-
signed to discriminate normal cognitive aging (NC) from depression, mild
cognitive impairment (MCI) and mild dementia (MD) due to Alzheimer’s
disease and related disorders (ADRD). Previous analysis of HBC classifica-
tion performance on a community sample of 295 subjects (93 [32%] normal,
137 [46%] MCI, 65 [22%] MD), gave specificity for normal aging ¼ 82%,
plus sensitivities for MCI and MD were 85% and 92% respectively. The
present study validates the HBC on a larger community sample. Methods:
TheHBCwas administered as part of the cognitive assessment service of the
Orange County Vital Aging Program (OCVAP)-a population-based cogni-
tive healthcare program designed to educate public and professionals,
plus provide effective screening for maintaining cognitive health. The Func-
tional Assessment Staging Test procedure was used to independently clas-
sify 2,016 subjects into normal aging (FAST 1: N¼323 [16%]), subjective
cognitive impairment (FAST 2: N¼1097 [54%]), MCI (FAST 3: N¼433
[21%]), and MD (FAST 4: N¼163 [8%]). The HBC scoring rule-developed
from the initial HBC study, and listed on the instrument-was used to classify
707 subjects as normal (FAST 1) or impaired (FAST 3,4). As previously
done, FAST 2 subjects were excluded because they are a mix of normal
and ADRD subjects. Results: HBC specificity for normal ¼ 85.6%, sensi-
tivity for MCI/MD ¼ 87.2%, and overall accuracy ¼ 86.4% 6 2.6%.
Conclusions: The HBC appears to be a valid instrument for differentiating
normal aging from MCI and MD in routine clinical practice or population
healthcare settings.
P4-170 LONGITUDINAL COGNITIVE CHANGES IN
VISUAL, VERBAL AND VISUAL-VERBAL
AMNESTIC MILD COGNITIVE IMPAIRMENT
Byoung Seok Ye1, Ju Hee Chin1, Seong Yoon Kim2, Jung Sun Lee2, Eun-
Joo Kim3, Yunhwan Lee4, Chang Hyung Hong4, Seong Choi5,
Kyung Won Park6, Bon Ku7, So Moon8, Sang Yun Kim9, Han Seol-Heui10,
Jae-Hong Lee2, Hae-Kwan Cheong11, Dong Won Yang12, Min-
Jeong Kim13, Duk L. Na14, Sang Won Seo14, 1Samsung Medical Center,
Seoul, South Korea; 2Asan Medical Center, Seoul, South Korea; 3Pusan
National University School of Medicine, Busan, South Korea; 4Ajou
University School of Medicine, Suwon, South Korea; 5Inha University
School of Medicine, Incheon, South Korea; 6Dong-A University College of
Medicine, Busan, South Korea; 7Kwandong University Myungji Hospital,
Goyang, South Korea; 8Ajou University, School of Medicine, Suwon, South
Korea; 9Department of Neurology, Seoul National University Budang
Hospital, Seongnam-si, South Korea; 10Konkuk University School of
Medicine, Seoul, South Korea; 11Sungkyunkwan University School of
Medicine, Suwon, South Korea; 12Sungkyunkwan University School of
Medicine, Seoul, South Korea; 13Seoul National University Hospital
Healthcare System Gangnam Center, Seoul, South Korea; 14Samsung
Medical Center, SungkyunkwanUniversity School of Medicine, Seoul, South
Korea. Contact e-mail: [email protected]
Background: Patients with amnestic mild cognitive impairment (aMCI)
can be classified into visual memory impairment group (Visual-aMCI), ver-
bal memory impairment group (Verbal-aMCI), and both visual and verbal
Poster Presentations: P4 P769
memory impairment group (Both-aMCI), according to the performance in
the memory tests applied to diagnose aMCI. A previous study suggested
there were the hierarchical order in the cortical thinning among three
aMCI groups. However, to our knowledge, the rates of Alzheimer’s disease
(AD) progression between three aMCI groups have not been compared.
Methods: From a multicenter hospital-based registry (CREDOS), we en-
rolled 562 aMCI patients and performed a prospective cohort study with
mean follow-up duration of 19.7 months. There were 136 patients with Vi-
sual-aMCI, 135 with Verbal-aMCI, and 291 with Both-aMCI. The risks of
AD progression between three aMCI groups were compared with Cox pro-
portional hazard analyses using age, gender, and education as covariates.
Gender-specific mixed effect models were used to compare longitudinal
changes in neuropsychological scores according to aMCI subgroups.
Results: During mean follow-up duration of 19.7 months, 176 (31.3%) pa-
tients progressed to AD and 48 (8.5%) reverted to normal cognition. Verbal-
aMCI group (adjusted HR: 1.80, 95% CI: 1.04-3.12) and Both-aMCI group
(2.44, 1.55-3.84) had significantly higher risks of AD progression compared
with Visual-aMCI group. In female patients, Visual-aMCI group exhibited
slower decline in visuospatial function test, MMSE, and Clinical Deteriora-
tion Rating Sum of Boxes (CDR-SOB) than Both-aMCI group. In male pa-
tients, Verbal-aMCI group exhibited slower deterioration in language,
attention, visual memory recognition tests, and CDR-SOB than Both-
aMCI group. Conclusions: Our findings suggest that Visual-aMCI group
might be an earlier stage of developing AD or composed of pathologically
heterogeneous entities other than AD. Gender-specific cognitive reserve
might explain the slower cognitive decline in female Visual-aMCI and
male Verbal-aMCI group.
P4-171 RISK SCORE FOR THE PREDICTION OF
ALZHEIMER’S DISEASE PROGRESSION IN
PEOPLE WITH AMNESTIC MILD COGNITIVE
IMPAIRMENT: A MULTICENTER, CLINIC-BASED
LONGITUDINAL STUDY
Byoung Seok Ye1, Ju Hee Chin1, Seong Yoon Kim1, Jung Sun Lee2, Eun-
Joo Kim3, Yunhwan Lee4, Joung Hwan Back4, Chang Hyung Hong4,
Seong Choi5, KyungWon Park6, Bon Ku7, SoMoon8, Sang Yun Kim9, Seol-
Heui Han10, Jae-Hong Lee2, Hae-Kwan Cheong11, Dong Won Yang12,
Duk L. Na13, Sang Won Seo13, 1Samsung Medical Center, Seoul, South
Korea; 2Asan Medical Center, Seoul, South Korea; 3Pusan National
University School of Medicine, Busan, South Korea; 4Ajou University
School of Medicine, Suwon, South Korea; 5Inha University School of
Medicine, Incheon, South Korea; 6Dong-A University College of Medicine,
Busan, South Korea; 7Kwandong University Myungji Hospital, Goyang,
South Korea; 8Ajou University, School of Medicine, Suwon, South Korea;9Department of Neurology, Seoul National University Budang Hospital,
Seongnam-si, South Korea; 10Konkuk University College of Medicine,
Seoul, South Korea; 11Sungkyunkwan University School of Medicine,
Suwon, South Korea; 12Catholic University of Korea, Seoul St. Mary’s
hospital, Department of Neurology, Seoul, South Korea; 13SamsungMedical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Contact e-mail: [email protected]
Background: Patients with amnestic mild cognitive impairment (aMCI) are
at a high risk to develop Alzheimer’s disease (AD). Several clinical features
of aMCI have been identified to predict future AD progression: older age,
more severe memory impairment (Late-stage-aMCI compared to Early-
stage-aMCI); additional impairments in cognitive domains plus memory do-
main (Multiple-aMCI compared to Single-aMCI); and objective memory
impairment on verbal-memory test or on both verbal- and visual-memory
tests rather than that only on visual-memory test (Both-aMCI and Verbal-
aMCI compared to Visual-aMCI). We aimed to develop a risk score calcu-
lation method to predict the risk of future AD progression in aMCI patients.
Methods: From a multicenter hospital-based registry (CREDOS), 567
aMCI patients were followed with mean follow-up duration of 1.64 years.
Logistic regression analyses were applied to create a risk score system.
To make scoring system simple and easy to understand, all variables includ-
ing age (with cut-off year of 70) and education (with cut-off year of nine)
were changed to dichotomous variable or variables with three groups. The
risk score for each variable was estimated on the basis of respective beta co-
efficient and the dementia risk score was the sum of these individual scores
(range 0-106). Results: Occurrence of AD dementia during follow-up pe-
riod was 31.0%. Future dementia was significantly predicted by older age
(> 70 years), the multiplicity of involved cognitive domains (Multiple-
aMCI compared to Single-aMCI), the modality of involved memory
dysfunction (Both- and Verbal-aMCI compared to Visual-aMCI), and the
interaction between education and the severity of memory dysfunction. Pa-
tients with higher education (� 9 years) had higher risk of AD progression
when they had Late-stage-aMCI than Early-stage-aMCI. The risk scores
based on these aMCI features predicted AD progression well (area under
curve 0.71; 95% CI 0.67-0.75). Conclusions: The dementia risk score is
a useful approach for the prediction of dementia risk among aMCI subjects,
but should be validated and further improved to increase its predictive value.
This approach showed that several clinical aspects of aMCI significantly
predict future AD progression and could help to identify candidates for fu-
ture interventional studies for AD.
P4-172 IMPROVEMENTOF THE SCREENINGACCURACY
OF THE MINI-MENTAL STATE EXAMINATION
FOR MILD COGNITIVE IMPAIRMENTAND
DEMENTIA BY SUPPLEMENTATION OF VERBAL
FLUENCY PERFORMANCE
Bo Kyung Sohn1, Dong Young Lee1, Jee Wook Kim2, Eun Hyun Seo3,
Young Min Choe4, Shin Gyeom Kim5, Shin Young Park6, IL Han Choo7,
Jong Chul Youn8, Jin Hyeong Jhoo9, Ki Woong Kim10, Jong Inn Woo11,1Seoul National University, Seoul, South Korea; 2Department of
Neuropsychiatry, Hallym University Hangang Sacred Heart Hospital,
Seoul, South Korea; 3Seoul National Univeristy, Seoul, South Korea;4Department of Neuropsychiatry, Seoul, South Korea; 5School of Medicine
Soon Chun Hyang University, Kyunggi, South Korea; 6Daelim Saint Mary’s
Hospital, Seoul, South Korea; 7Chosun University, Seoul, South Korea;8Kyunggi Provincial Hospital for the Elderly, Younginsi, South Korea;9Kang won University, Chuncheon, South Korea; 10Seoul National
University Bundang Hospital, Seongnamsi, South Korea; 11Seoul National
University Hospital, Seoul, South Korea. Contact e-mail: bksohn1221@
hanmail.net
Background: This study aimed to investigate whether supplementation of
Verbal Fluency: animal category test (VF) performance can improve the
screening ability of MMSE for mild cognitive impairment (MCI), dementia,
and their major subtypes. Methods: Six hundred fifty-five cognitively nor-
mal (CN), 366 MCI (282 amnestic MCI [aMCI]; 84 non-amnestic MCI
[naMCI]) and 494 dementia (346 Alzheimer’s disease [AD]; and 148 non-
Alzheimer’s disease dementia [NAD]) individuals living in the community
were included (all aged 50 years and older). Results: WF-supplemented
MMSE (MMSE+WF) score had significantly better screening ability for
MCI, dementia, and overall cognitive impairment (MCI plus dementia)
than MMSE raw score alone. MMSE+WF showed significantly better abil-
ity than MMSE for both MCI subtypes, i.e., aMCI and naMCI. In case of
dementia subtypes, MMSE+WF was better than MMSE alone for NAD
screening, but not for AD screening. Conclusions: The results support the
usefulness of WF-supplementation to improve screening performance of
MMSE for MCI, dementia, and overall cognitive impairment.
P4-173 CHANGES IN CEREBRALVASCULAR
REACTIVITY IN ELDERLY WITH MILD
COGNITIVE IMPAIRMENT: VASCULAR
CASE-CONTROL STUDY
Alberto Mimenza, Sara Aguilar, Sandra Ju�arez Arellano,
Carolina Bernal L�opez, Alejandra Samudio Cruz, Alberto �Avila Funes,
Instituto Nacional de Ciencias M�edicas y Nutrici�on Salvador Zubir�an,M�exico, DF, Mexico. Contact e-mail: [email protected]
Background: One theory for the development of cognitive impairment, is
the microvascular brain damage, which has been associated with reduced
