P1‐049: The need for a new practical Alzheimer's disease scale

Conclusions: Results on safety and adherence will be presented at the time of the meeting. P1-049 THE NEED FOR A NEW PRACTICAL ALZHEIMER’S DISEASE SCALE Philippe Robert, Steven Ferris, Serge Gauthier, Gudrun Gatz, Bengt Winblad, Frank Tennigkeit, Université de Nice Sophia Antipolis, Nice, France; Alzheimer’s Disease Center, New York University School of Medicine, NY and Nathan Kline Institute, Orangeburg, NY, USA; McGill Centre for Studies in Aging, Montreal, QC, Canada; Merz Pharmaceuticals, Frankfurt am Main, Germany; Karolinska Institutet, Alzheimer Center, Stockholm, Sweden. Contact e-mail: philippe.robert15@wanadoo.fr Background: Alzheimer’s disease (AD) leads to progressive loss of everyday competence and heterogeneous symptoms. This bears a challenge for an adequate and comprehensive assessment instrument for daily medical practice and care of patients with AD. Objectives: To evaluate the requirements for a multi-domain AD scale to be used in daily clinical practice, and analyze the existing scales which may meet these demands. Methods: A national expert panel comprising medical and caregiver experts was consulted to define requirements for an AD scale in medical practice. An extensive literature search was subsequently performed to identify existing scales fulfilling these requirements. The results were evaluated and discussed by the international expert panel. Results: The extensive literature search showed that most scales used in AD research so far do not comprise all relevant domains, are not applicable to all severity stages and are often time-consuming and difficult to administer. In view of these results and from the comprehensive discussions at the expert panel meetings, it was concluded that an ideal scale in medical AD practice should allow easy and quick administration and cover the following relevant domains: cognition, activities of daily living, behavior, communication/social interaction, quality of life and caregiver burden. The information of patient and caregiver should be taken into account. Such a scale should also enable monitoring of disease progression and the assessment of therapy effects; it should be applicable to all severity stages, reliable and validated for AD research. Conclusions: It appears that a multi-domain and easy-administrable AD scale for daily medical practice does not exist so far. There is a need to develop a valid scale for medical AD practice which should cover all the relevant domains and severity stages, allow easy and quick administration, enable monitoring of disease progression and the assessment of therapy effects. P1-050 CLINICAL PROFILE OF ALZHEIMER’S DISEASE (AD)-A STUDY FROM NORTH INDIA Suman Kushwaha, Sunil Pradhan, D. C. Jain, Meena Gupta, Kiran Bala, Institute of Human Behavior & Allied Sciences, Delhi, India. Contact e-mail: sumankushwaha@gmail.com Background: Alzheimers Disease, heterogenous & progressive disorder. It is emerging as a modern pandemic. It is important to recognize this treatable disease early in course for reducing the burden on healthcare services. Methods: Objective To study the clinical profile, therapeutic interventions and outcome of AD Patients. Material & Method Duration 5 yrs (20032008). Study was done at Neurobehavioural Clinic, Neurology Department, Pts were evaluated clinically by taking history. Examination includes MMSE Scores, higher mental status & Neurological & Neuropsychological assessment. Routine Laboratory test, thyroid function, Vit B12, folic acid & Homocystine levels were done for co morbid conditions. Neuroimaging done in all patients. Patients were given specific treatment & followed for an average period of 2-4 yrs. Results: No of pts -164. Age range is 50 -90 yrs. Male 70, Female 94. Duration of illness 4 months to 5.6 yrs. Memory impairment was commonest presentation, 120 pts (73%) followed by Behavioural disturbances in 64%. The pts were sub divided into three categories on MMSE score Mild, Moderate & Severe. Higher mental functions assessment revealed temporal & parital lobe dysfunctions in 70% of pts. Neuropsychiatry inventory showed depression and agitation in severe group. Motor system examination was grossly normal. All the pts fulfilled NINCDS-ADARDA Criteria Laboratory investigations shows Vit B12 deficiency in 20% pts. 35% were Diabetic, Hyperhomocystenemia in 10% while Raised Cholesterol levels in 18%. MRI/CT was done in all patients, showing generalised atrophy of varying degree. SPECT brain revealed hypoperfusion in temporal, frontal & parital area in pts of early dementia.. Choline esterase inhibitors was given to all pts with NMDA receptor antagonist to 28 pts. Antipsychotics were given to 40% pts. Co morbid conditions treated. Out come on 2-4 yrs follow up shows improvement in 34(21%) Behaviour, ADLs & cognition ,66 pts (42%) stable. 28% deteriorated, 15% pts lost follow up. Conclusions: AD is clinically diagnosable and treatable disorder. Early and correct diagnosis along with timely interventions with available treatment options will be helpful in reducing the burden of this modern pandemic. P1-051 APPLICATION OF AD-8 TO SCREEN VERY MILD DEMENTIA IN TAIWAN Ching-Kuan Liu, Mei-Chuan Chou, Chiou-Lian Lai, Yuan-Han Yang, Kaohsiung Medical University, Kaohsiung, Taiwan. Contact e-mail: ckliu@ kmu.edu.tw Background: By 2040, Asia will have the highest prevalence of dementia compared to other area. Physicians hope the demented patients can be diagnosed at their earlier stage in order to have desirable therapeutic outcomes. Therefore, easy-to-administer sensitive clinical tools to screen whether people have very mild dementia are expected. The AD-8 scale was developed with higher sensitivity and specificity from Washington University in St Louis to efficiently capture individuals at their very mild dementia. The AD8 is a brief informant-based measure that reliably differentiates non-demented from demented individuals and is sensitive to the earliest signs of cognitive change as reported by an informant. However, given to the different cultural background, we do not know whether the AD-8 is practicable to screen very mild dementia in Taiwanese. We conduct a study to examine the application of AD-8 to screen very mild dementia in Taiwanese. Methods: Participants were recruited from Alzheimer’s disease research center in Kaohsiung Medical University Hospital, a medical center in southern Taiwan. Diagnosis of dementia of Alzheimer’s type was made according to DSM-IV criteria and referring to neuropsychological test. The English-version AD-8 questionnaire was translated into Chinese and back translated to English to make sure the translative accuracy. For each participant, the clinical dementia rating (CDR) scale and AD-8 were administrated simultaneously during their each assessment. Receiver operating characteristic (ROC) curve was conduct to determine the cut-off values of Chinese version AD-8 in discriminating non-demented from very mild or mild dementia participants. Results: Two hundreds and thirty-nine participants, including 114 non-demented (CDR0), 73 very mild dementia (CDR0.5), and 52 mild dementia (CDR1) were recruited. The cut-off value of discriminating non-demented subjects (CDR 0) from very mild dementia (CDR 0.5) or from dementia (CDR0.5 and CDR1) was 2 in both groups. The sensitivity 95.89%, specificity 78.07%, and area under curve (AUC) 0.948 were high in discriminating CDR 0 from CDR 0.5 group. In CDR0 versus CDR0.5 and CDR1 group, the sensitivity and specificity were 97.6% and 78.07%, respectively, and AUC was 0.961. Conclusions: AD-8 is a brief and sensitive instrument that can reliably differentiate non-demented from demented, even in very mild stage, subjects in Taiwanese. P1-052 THE CLINICAL CHARACTERISTICS OF THE JAPANESE PEDIGREE OF FAD WITH PS1 H163R MUTATION Toji Miyagawa, Atsushi Iwata, Hisatomo Kowa, Takeshi Kawarabayashi, Mikio Shoji, Shoji Tsuji, Toshimitsu Momose, Yoshiki Kojima, University of Tokyo, Tokyo, Japan; Hirosaki University, Hirosaki, Aomori, Japan; Hirosaki University, Hirosaki, Aomoni, Japan; University of Tokyo, Bunkyo-ku, Japan. Contact e-mail: tmiyagawa-tky@ umin.ac.jp Background: The mutations of Presenilin 1 (PS1) are the most common genetic cause of familial Alzheimer’s disease (FAD), but few detailed descriptions of the clinical phenotype have been reported. Methods: We investigated phenotypic variations of the FAD with H163R mutation in PS1 by examining the 2 patients including neuropsychological profile and taking histories of other 12 patients from family members. Genetic analyses