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P4‐288: DETAILS OF THE NEW ALZHEIMER'S ASSOCIATION BEST CLINICAL PRACTICE GUIDELINES FOR THE EVALUATION OF NEURODEGENERATIVE COGNITIVE BEHAVIORAL SYNDROMES, ALZHEIMER'S DISEASE AND DEMENTIAS IN THE UNITED STATES
Author(s) -
Atri Alireza,
Knopman David S.,
Norman Mary,
Karlawish Jason,
Sano Mary,
Onyike Chiadi U.,
Lin Paige,
Clevenger Carolyn,
Scanland Susan,
Hendrix James,
Carrillo Maria C.,
Dickerson Brad C.
Publication year - 2018
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2018.07.110
Subject(s) - workgroup , dementia , specialty , medicine , best practice , disease , multidisciplinary approach , cognition , medline , cognitive decline , psychiatry , psychology , pathology , computer network , social science , management , sociology , computer science , political science , law , economics
mostly been studied in relation to Alzheimer’s Disease(AD). As loss of functional independence is a feature of all dementia diagnoses, we investigated if WMHs predict activities of daily living (ADL) in a cohort of dementia patients with AD or Dementia with Lewy Bodies (DLB), and if this association is influenced by specific dementia-diagnosis.Methods:In the Sunnybrook Dementia Study, we examined if WMHs are associated with ADLs crosssectionally in 277 dementia patients with varying degrees of cerebral small vessel disease (AD1⁄4227, DLB1⁄450), and longitudinally in 164 patients (AD1⁄4136, DLB1⁄428), in which ADL were reassessed afterw1.5 years. All patients underwent standardized volumetric MRI, and ADL and neuropsychiatric assessment. Total WMH volumes were quantified by semiautomatic segmentation using Lesion Explorer. Basic and instrumental ADL (BADL and IADL) were assessed by Disability Assessment for Dementia scale. Multiple linear regression models adjusted for age, sex, global cognition (Mini-Mental-State Examination-MMSE), and neuropsychiatric symptoms (Neuropsychiatric-Inventory), were used to test if WMH volume predicts ADL in a cohort of AD and DLB patients combined. Longitudinal analyses were adjusted additionally for baseline ADL score and time between two ADL assessments. After testing an interaction between WMHs and diagnosis, we subsequently tested the association of WMH and ADL in models stratified for diagnosis. Results: Of the 277 patients (Mean age 70.8610.0 years), 52 % (n1⁄4145) were women. Compared to DLB, AD patients were older (P1⁄4<0.001), had lower MMSE (P1⁄40.02) and neuropsychiatric symptoms(P1⁄4<0.001), and higher WMH-volume at baseline (AD1⁄46.668.8cc;DLB1⁄43.264.1cc; P1⁄40.01). In the combined sample, patients with higher WMH volume were more likely to perform worse on BADL (Interaction-pvalue WMHs and diagnosis1⁄40.001) but not on IADL. In models stratified for diagnosis, higher WMH volume was associated with worse performance on BADL(Difference:-4.8,95%CI:-8.3,-1.4, p-value:0.007). and IADL(Difference:-4.7,95%CI:-9.7,0.3, p-value:0.06) in DLB patients only. In longitudinal analyses also, patients with higher WMH volume declined significantly on BADLs (decline(b)-7.3,95%CI:-13.8,-0.7,p-value:0.03) and IADLs (decline(b)-6.5,95%CI:-13.4,0.5,p-value:0.06) in the DLB group only. No associations were observed in AD patients. Conclusions:Despite the lower burden of WMHs, WMHs more strongly predicted ADLs in DLB than in AD patients. WMHs possibly interact with DLB pathology differently than with AD pathology consequently influencing functionality.