Poster Presentations P3: (AD⫹LBD). The clinical accuracy for AD was 97% but associated lesions were clinically missed in 10 cases (⫹Va in 8, ⫹LBD in 1 and ⫹progressive supranuclear palsy in 1). 94.1% of AD⫹VaD cases and 70% of AD⫹LBD were confirmed at post mortem. Three AD⫹DLB patients were misdiagnosed with confirmed AD⫹Va. Finally, associated lesions were present in 36 out of 58 patients (62%) with confirmed AD (27 MA⫹Va, 8 AD⫹LBD and 1 AD⫹progressive supranuclear palsy). In 2 cases the clinical diagnosis of AD was wrong: the final diagnosis was pure vascular dementia (n⫽1) and argyrophilic grains disease (n⫽1). Conclusions: Our data show that superimposed cerebral lesions are highly prevalent in AD and contribute to the cognitive decline of these patients and the clinicians’ diagnosis difficulties. We observed a frequent clinical overlap between AD and Va or LBD. We emphasize the need for improving the detection of associated vascular and neurodegenerative lesions during patient’s life, especially in older persons. Clinicians also need to confirm AD pathology with biomarkers in case of additional pathologies that may explain at least part of the cognitive decline. P3-009
DEVELOPMENT OF A LANGUAGE ASSESSMENT TOOL FOR PATIENTS WITH ALZHEIMER’S DISEASE
Jasmine Fokkens1, Steven Ferris2, Philippe Robert3, Bengt Winblad4, Serge Gauthier5, 1Merz Pharmaceuticals GmbH, Frankfurt, Germany; 2 Silberstein Institute for Aging and Dementia, New York University School of Medicine, New York, NY, USA; 3Centre Me´moire de Ressources et de Recherche du CHU de Nice, Hoˆpital Pasteur, Nice, France; 4Karolinska Institutet Alzheimer Disease Research Center, Huddinge, Sweden; 5Alzheimer’s Research Unit, McGill Centre for Studies in Aging, Verdun, QC, Canada. Contact e-mail:
[email protected] Background: Problems with communication and language are common in Alzheimer’s disease (AD), and can lead to patient difficulties, including feelings of frustration and isolation. Therefore, our objective was to develop a scale for language assessment in AD (based on the Severe Impairment Battery, SIB), thereby also providing a means for analyzing the specific effects of treatment on language performance. Methods: The scale was generated using predefined language-related items from the SIB. Once the items had been selected, they were assessed by factor analysis, using baseline data from an AD database of 1,320 patients with moderate to severe AD, collated from four studies (IE2101, MD-01, MD-02, MRZ-9605). Correlations were calculated between the new language scale and existing scales. Results: Of the 51 SIB items, 24 language-related items were initially chosen for inclusion in the new scale, which was designated the SIB Language (SIB-L) scale. Assessment of these items by principal components factor analysis revealed 6 factors, comprising 21 items with loadings ⬎0.5. The resulting 21-item SIB-L showed a high level of internal consistency (Cronbach’s ␣⫽0.8095). SIB-L has a maximum score of 41 points, with a measurement error of 3.7 points, and time for administration is ⬍15 min. Comparison with existing scales revealed a correlation of r⫽0.697 between MMSE (mean 9.7, SD 3.3) and SIB-L (mean 31.7, SD 8.4) scores, demonstrating that MMSE has a low predictive value for language. Comparison of SIB-L with the original SIB scale (mean 73.9, SD 18.5) showed a strong correlation (r⫽0.943), but there was a very low correlation (r⫽-0.096) between SIB-L and the Neuropsychiatric Inventory (NPI, mean 16.5, SD 14.4). SIB-L scores were wide ranging in patients with moderate AD - even patients with very low MMSE scores - suggesting no substantial floor and ceiling effects. Conclusions: In SIB-L, we have developed a scale for assessing language performance that is easy and quick (⬍15 min) to administer to patients with moderate to severe AD. SIB-L will be a useful clinical tool for assessing the potential benefits of treatment on the important area of language in AD.
P3-010
T519 ASSOCIATED VARIABLES TO MISDIAGNOSIS AMONG FRONTOTEMPORAL DEMENTIA (FTD) BEFORE EVALUATION BY SPECIALISTS
Letı´cia K. Forster, Ana Luiza Camozzato, Renata Kochhann, Claudia Godinho, Marcia Lorena Chaves, Hospital de Clı´nicas de Porto Alegre, Porto Alegre, Brazil. Contact e-mail:
[email protected] Background: Of all dementia patients seeing in the Neurogeriatric Clinic from 1999 on, only 6 were FTD. The importance of variables associated to misdiagnosis and to decision making for a tertiary clinic evaluation is critical. The aims of the study is to hypothesize which variables can be associated to misdiagnosis, considering the small size of the FTD sample. Methods: Six FTD patients, 10 patients evaluated for memory complaints/ suspicion of dementia, and 10 suspected Alzheimer’s disease, in the same period. Samples were balanced for criteria of entry in the study for the period, limiting to “typical” cases in each category after the expert evaluation. Variables: cause of referral, earlier diagnosis, previous behavioral and cognitive symptoms, Mini Mental State Exam, memory and other domains at expert evaluation, length of disease and outcome. Parametric data were analyzed by one-way ANOVA and Bonferroni post hoc, and association test with Fisher exact were carried out for categorical variables. Results: All AD, 90% of the suspicion of dementia group and 33% of FTD were referred by memory complaints to the specialist (p ⫽ 0.007). Most AD (80%) and few FTD (17%) have no previous diagnosis, while 1/3 of FTD (33%) and few AD (17%) were treated as depressed (p ⫽ 0.036). Most AD (70%) and suspicion of dementia (90%) reported memory symptoms during the expert evaluation, while only 33% of the FTD did (p ⫽ 0.003). 33% of the FTD reported oral communication problems. All AD and FTD patients presented scores bellow cutoff on the MMSE while all patients from the suspicion of dementia group were above cutoff (p ⫽ 0.0001). Duration since diagnosis was similar between AD and FTD. Conclusions: The most consistent cause of referral to the specialist was memory complaint. Among AD, most patients did not present earlier diagnosis, while among FTD depression and Alzheimer’s disease were frequent, and memory complaint and behavioral change were the common causes of referral. Detection of behavioral symptoms suggested that it might have influenced the way clinicians use to deal with these conditions and may have influenced the search for specific evaluations. P3-011
ANTIHYPERTENSIVE DRUG USE MODULATES PROGRESSION OF ALZHEIMER’S DISEASE
Katsutoshi Furukawa, Naoki Tomita, Takashi Ohrui, Hiroyuki Arai, Tohoku University School of Medicine, Sendai, Japan. Contact e-mail:
[email protected] Background: Some antihypertensive drugs are considered to decrease the incidence of AD or slow Alzheimer’s disease (AD) progression although some studies for antihypertensive drugs resulted in no effect on AD. In antihypertensive drugs, angiotensin converting enzyme inhibitors (ACE-Is) have had attention in Alzheimer’s disease progression because the renin angiotensin system plays an important role in brain functions especially in cognition and learning. Our group previously presented that some brainpenetrating ACE-Is can slow the rate of cognitive decline in mild-tomoderate AD patients with hypertension (Ohrui et al. Neurology, 2004). Methods: We examined mini mental state examination (MMSE) scores every year for 2 years during exposure to one of the antihypertensive drugs to study medications. Patients with mild to moderate AD were recruited from outpatient clinics. Patients eligible for this study had a diagnosis of mild to moderate AD, were aged 64 years and older, had MMSE scores within the range of 18 to 27, and had a blood pressure of higher than 140 mmHg systolic or 90 mmHg diastolic. The diagnosis of probable AD was made according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association criteria with no clinical or laboratory evidence of a cause other than AD for dementia. Results: We screened 114 AD patients with hypertension taking an antihypertensive drug. All the patients examined took
