P3-016: The APOE-ϵ4 allele does not affect rate of cognitive and functional decline in late-onset...
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treatment will be essential. The present study reports treatment efficacy of an AD patient who was first diagnosed four months after developing progressive memory loss and multi-tasking difficulties. The patient has been monitored for 61 months. Methods: Single patient, repeated mea- sures, cross-over treatment study of a 71-year-old male who fulfilled Petersen criteria for amnestic mild cognitive impairment, had a Functional Assessment Staging Test (FAST) level of 3. MRI was negative, with no entorhinal/hippocampal and no generalized atrophy. FDG PET scanning showed selective bilateral entorhinal/hippocampal hypometabolism. Apo- lipoprotein E genotype was E3/E3; labs were negative. Cholinesterase inhibitor therapy (rivastigmine, 12 mg/day) was initiated. Results: The patient reverted from FAST stage 3 to 1 within 3 months after beginning rivastigmine. Delayed recall improved 30% from baseline after three months of rivastigmine. Repeat FDG PET scans 5, 28 and 51months post-baseline showed initial increase in cortical and entorhinal/hippocam- pal activity, then return to baseline. He remained cognitively and function- ally normal for 28 months then episodic memory and multi-tasking im- pairments returned. Memantine, 10 mg/day, re-normalized memory and multi-tasking until 48 months post-baseline, then he declined. Randomiza- tion into the tarenflurbil trial renormalized memory and multi-tasking as of the last assessment at 61 months. Repeat MRI (1/2008) showed progression of left hippocampal atrophy without cortical atrophy. Conclusions: De- tecting and treating AD before atrophy develops can more effectively delay progression than starting later. P3-016 THE APOE-4 ALLELE DOES NOT AFFECT RATE OF COGNITIVE AND FUNCTIONAL DECLINE IN LATE-ONSET ALZHEIMER’S DISEASE (AD): FINDINGS FROM THE U.K. MEDICAL RESEARCH COUNCIL (MRC) GENETIC RESOURCE FOR AD Paul Hollingworth 1 , Kimberley Dowzell 1 , Amy Williams 1 , Sophie Keates 1 , Richard Abraham 1 , Angharad Morgan 1 , Catherine Foy 1 , Nicola Archer 1 , John Powell 1 , Simon Lovestone 2 , Michael O’Donavan 1 , Michael J. Owen 1 , Julie Williams 1 , 1 Cardiff University School of Medicine, Cardiff, United Kingdom; 2 Institute of Psychiatry, London, United Kingdom. Contact e-mail: [email protected] Background: The MRC genetic resource for AD is a powerful genetic association sample for late-onset AD (LOAD). The sample comprises 1501 individuals with probable LOAD and 1645 unrelated healthy age and sex matched controls ascertained in the UK. All cases and controls were diagnosed with the same assessment interview, with a proven positive predictive value of 92-95% for the detection of AD neuropathology. AD cases are well defined in terms of cognition, functional ability, behavioral symptoms, family and medical history. This sample has genotypes avail- able for 550,000 single nucleotide polymorphisms, genotyped as part of our genome-wide association study. The wealth of phenotypic information in this sample provides a valuable resource for researchers aiming to investigate complex phenotypic-genotypic relationships in LOAD. APOE is the only well-established genetic risk factor for LOAD. The APOE 4 allele is also thought to reduce age at disease onset in a dose dependent manner. This has led some to hypothesize that the APOE 4 allele may be associated with a more severe phenotype, characterized by a more rapid rate of decline. However, the findings to date are inconclusive. Objective: We aimed to investigate the relationship between APOE and rate of functional and cognitive decline in AD. Methods: Four hundred and forty LOAD cases were APOE genotyped and completed either one or two follow up assessments (mean interval between assessments: 1.37 years). Results: The APOE4 allele was strongly associated with LOAD risk in the full sample, P 1.56 10(-54). After controlling for educational level and use of cholinesterase inhibitors, the APOE 4 allele was not associated with the rate of functional or cognitive decline. The results remained consistent in analyses stratified by age at disease onset. Conclusions: Our findings confirm that although APOE increases the risk of AD and de- creases the age of disease onset, it does not exert any influence on the rate of cognitive and functional decline in AD. This study serves to highlight how the MRC genetic resource for AD can be utilized in future to inves- tigate complex phenotypic-genotypic relationships in AD. P3-017 COMPARISON OF CLINICAL AND PATHOLOGICAL DIAGNOSES IN A SPECIALIZED DEMENTIA CLINIC COHORT Ging-Yuek R. Hsiung, Howard H. Feldman, Ian R. A. Mackenzie, University of British Columbia, Vancouver, BC, Canada. Contact e-mail: [email protected] Background: Recent studies suggest that multiple pathologies are com- mon in patients with dementia. This can complicate clinical diagnosis and management of patients with dementia. In this study, we compared the agreement between clinical and pathological diagnoses in a cohort of patients followed in a specialized dementia clinic, and examined the factors that affect the diagnostic accuracy of dementia syndromes. Methods: We examined autopsy results at a single center within the ACCORD longitu- dinal cohort (inception1997-1999). Clinical diagnoses were made prospec- tively according to published criteria for Alzheimer Disease (AD by NINCDS-ADRDA), Dementia with Lewy Bodies (DLB by McKeith), and Frontotemporal Dementia (FTD by Lund Manchester). Vascular dementia (VaD) was diagnosed by clinical and radiological criteria. Accuracy of the clinical diagnoses was assessed using Kappa statistic for agreement with pathological diagnoses. Results: To date, 41 patients had autopsy in a cohort of 230 patients. The overall agreement between primary clinical diagnosis and primary pathological diagnosis was fair ( 0.36, with 76% concordance). Multiple pathologies were present in 16 cases (39%). Diag- nostic agreement was very high ( 0.603, 84%) in cases with single pathology, but poor in cases with multiple pathology ( -0.04, 40%). Agreement between clinical and pathological FTD diagnoses was highest, which was not affected when other pathologies were present, but diagnostic agreement dropped significantly for AD and VaD when multiple patholo- gies were present. DLB was the most commonly missed diagnosis (only 2/8 cases diagnosed pre-mortem), and all 8 cases presented as multiple pathologies. Other conditions contributing to mis-diagnosis of AD include argyrophilic grain disease, neurofibrillary tangle-only disease, and fronto- temporal dementia. Conclusions: Pre-mortem clinical diagnoses using clinical criteria were very good for cases with single pathology, but not so when multiple pathologies were present. Since disease specific therapies are in the horizon, ways to improve our pre-mortem diagnostic accuracy, especially when multiple pathologies are present, are urgently needed. P3-018 ALZHEIMER’S DISEASE PRESENTING AS CORTICOBASAL SYNDROME William T. Hu 1 , Gregory A. Rippon 2 , Bradley F. Boeve 1 , Joseph E. Parisi 1 , David S. Knopman 1 , Ronald C. Petersen 1 , Keith A. Josephs 1 , 1 Mayo Clinic College of Medicine, Rochester, MN, USA; 2 Cephalon, Frazer, PA, USA. Contact e-mail: [email protected] Background: Patients with Alzheimer disease (AD) can present clinically with corticobasal syndrome (CBS). We reviewed the clinical features of these patients (CBS-AD) and compared them with patients with corticobasal degen- eration (CBD). Methods: Clinical and historical features of patients with pathologically-confirmed AD and clinical diagnosis of CBS (Boeve, Lang, Litvan, 2003) from 1970-2005 were retrospectively reviewed and compared with patients with clinical CBS and pathologically confirmed CBD. Results: Five patients with clinical CBS and pathologic AD were identified, along with 12 patients with clinical CBS and pathologic CBD. CBS-AD patients were younger at symptomatic onset (median 58 vs. 67 yrs, p 0.001) but had similar disease durations as CBS-CBD patients (median 6 vs. 5.5 yrs). Rigidity and apraxia were common in both groups, but CBS-CBD patients were more likely to have tremor (7/12 vs. 0/5, p 0.04). Dysexecutive features, episodic memory loss, visuospatial/perceptual and other parietal lobe deficits did not significantly differ between the two groups. Varying degrees of frontal and parietal atrophy and increased T2 and FLAIR signal changes on head MRI T521 Poster Presentations P3:
Transcript of P3-016: The APOE-ϵ4 allele does not affect rate of cognitive and functional decline in late-onset...
treatment will be essential. The present study reports treatment efficacy ofan AD patient who was first diagnosed four months after developingprogressive memory loss and multi-tasking difficulties. The patient hasbeen monitored for 61 months. Methods: Single patient, repeated mea-sures, cross-over treatment study of a 71-year-old male who fulfilledPetersen criteria for amnestic mild cognitive impairment, had a FunctionalAssessment Staging Test (FAST) level of 3. MRI was negative, with noentorhinal/hippocampal and no generalized atrophy. FDG PET scanningshowed selective bilateral entorhinal/hippocampal hypometabolism. Apo-lipoprotein E genotype was E3/E3; labs were negative. Cholinesteraseinhibitor therapy (rivastigmine, 12 mg/day) was initiated. Results: Thepatient reverted from FAST stage 3 to 1 within 3 months after beginningrivastigmine. Delayed recall improved 30% from baseline after threemonths of rivastigmine. Repeat FDG PET scans 5, 28 and 51monthspost-baseline showed initial increase in cortical and entorhinal/hippocam-pal activity, then return to baseline. He remained cognitively and function-ally normal for 28 months then episodic memory and multi-tasking im-pairments returned. Memantine, 10 mg/day, re-normalized memory andmulti-tasking until 48 months post-baseline, then he declined. Randomiza-tion into the tarenflurbil trial renormalized memory and multi-tasking as ofthe last assessment at 61 months. Repeat MRI (1/2008) showed progressionof left hippocampal atrophy without cortical atrophy. Conclusions: De-tecting and treating AD before atrophy develops can more effectively delayprogression than starting later.
P3-016 THE APOE-�4 ALLELE DOES NOT AFFECTRATE OF COGNITIVE AND FUNCTIONALDECLINE IN LATE-ONSET ALZHEIMER’SDISEASE (AD): FINDINGS FROM THE U.K.MEDICAL RESEARCH COUNCIL (MRC)GENETIC RESOURCE FOR AD
Paul Hollingworth1, Kimberley Dowzell1, Amy Williams1,Sophie Keates1, Richard Abraham1, Angharad Morgan1, Catherine Foy1,Nicola Archer1, John Powell1, Simon Lovestone2, Michael O’Donavan1,Michael J. Owen1, Julie Williams1, 1Cardiff University School ofMedicine, Cardiff, United Kingdom; 2Institute of Psychiatry, London,United Kingdom. Contact e-mail: [email protected]
Background: The MRC genetic resource for AD is a powerful geneticassociation sample for late-onset AD (LOAD). The sample comprises 1501individuals with probable LOAD and 1645 unrelated healthy age and sexmatched controls ascertained in the UK. All cases and controls werediagnosed with the same assessment interview, with a proven positivepredictive value of 92-95% for the detection of AD neuropathology. ADcases are well defined in terms of cognition, functional ability, behavioralsymptoms, family and medical history. This sample has genotypes avail-able for 550,000 single nucleotide polymorphisms, genotyped as part ofour genome-wide association study. The wealth of phenotypic informationin this sample provides a valuable resource for researchers aiming toinvestigate complex phenotypic-genotypic relationships in LOAD. APOEis the only well-established genetic risk factor for LOAD. The APOE �4allele is also thought to reduce age at disease onset in a dose dependentmanner. This has led some to hypothesize that the APOE �4 allele may beassociated with a more severe phenotype, characterized by a more rapidrate of decline. However, the findings to date are inconclusive. Objective:We aimed to investigate the relationship between APOE and rate offunctional and cognitive decline in AD. Methods: Four hundred and fortyLOAD cases were APOE genotyped and completed either one or twofollow up assessments (mean interval between assessments: 1.37 years).Results: The APOE �4 allele was strongly associated with LOAD risk inthe full sample, P � 1.56 � 10(-54). After controlling for educational leveland use of cholinesterase inhibitors, the APOE �4 allele was not associatedwith the rate of functional or cognitive decline. The results remainedconsistent in analyses stratified by age at disease onset. Conclusions: Ourfindings confirm that although APOE increases the risk of AD and de-creases the age of disease onset, it does not exert any influence on the rate
of cognitive and functional decline in AD. This study serves to highlighthow the MRC genetic resource for AD can be utilized in future to inves-tigate complex phenotypic-genotypic relationships in AD.
P3-017 COMPARISON OF CLINICAL ANDPATHOLOGICAL DIAGNOSES IN ASPECIALIZED DEMENTIA CLINIC COHORT
Ging-Yuek R. Hsiung, Howard H. Feldman, Ian R. A. Mackenzie,University of British Columbia, Vancouver, BC, Canada. Contacte-mail: [email protected]
Background: Recent studies suggest that multiple pathologies are com-mon in patients with dementia. This can complicate clinical diagnosis andmanagement of patients with dementia. In this study, we compared theagreement between clinical and pathological diagnoses in a cohort ofpatients followed in a specialized dementia clinic, and examined the factorsthat affect the diagnostic accuracy of dementia syndromes. Methods: Weexamined autopsy results at a single center within the ACCORD longitu-dinal cohort (inception1997-1999). Clinical diagnoses were made prospec-tively according to published criteria for Alzheimer Disease (AD byNINCDS-ADRDA), Dementia with Lewy Bodies (DLB by McKeith), andFrontotemporal Dementia (FTD by Lund Manchester). Vascular dementia(VaD) was diagnosed by clinical and radiological criteria. Accuracy of theclinical diagnoses was assessed using Kappa statistic for agreement withpathological diagnoses. Results: To date, 41 patients had autopsy in acohort of 230 patients. The overall agreement between primary clinicaldiagnosis and primary pathological diagnosis was fair (�0.36, with 76%concordance). Multiple pathologies were present in 16 cases (39%). Diag-nostic agreement was very high (�0.603, 84%) in cases with singlepathology, but poor in cases with multiple pathology (�-0.04, 40%).Agreement between clinical and pathological FTD diagnoses was highest,which was not affected when other pathologies were present, but diagnosticagreement dropped significantly for AD and VaD when multiple patholo-gies were present. DLB was the most commonly missed diagnosis (only2/8 cases diagnosed pre-mortem), and all 8 cases presented as multiplepathologies. Other conditions contributing to mis-diagnosis of AD includeargyrophilic grain disease, neurofibrillary tangle-only disease, and fronto-temporal dementia. Conclusions: Pre-mortem clinical diagnoses usingclinical criteria were very good for cases with single pathology, but not sowhen multiple pathologies were present. Since disease specific therapiesare in the horizon, ways to improve our pre-mortem diagnostic accuracy,especially when multiple pathologies are present, are urgently needed.
P3-018 ALZHEIMER’S DISEASE PRESENTING ASCORTICOBASAL SYNDROME
William T. Hu1, Gregory A. Rippon2, Bradley F. Boeve1,Joseph E. Parisi1, David S. Knopman1, Ronald C. Petersen1,Keith A. Josephs1, 1Mayo Clinic College of Medicine, Rochester, MN,USA; 2Cephalon, Frazer, PA, USA. Contact e-mail: [email protected]
Background: Patients with Alzheimer disease (AD) can present clinicallywith corticobasal syndrome (CBS). We reviewed the clinical features of thesepatients (CBS-AD) and compared them with patients with corticobasal degen-eration (CBD). Methods: Clinical and historical features of patients withpathologically-confirmed AD and clinical diagnosis of CBS (Boeve, Lang,Litvan, 2003) from 1970-2005 were retrospectively reviewed and comparedwith patients with clinical CBS and pathologically confirmed CBD. Results:Five patients with clinical CBS and pathologic AD were identified, along with12 patients with clinical CBS and pathologic CBD. CBS-AD patients wereyounger at symptomatic onset (median 58 vs. 67 yrs, p � 0.001) but hadsimilar disease durations as CBS-CBD patients (median 6 vs. 5.5 yrs). Rigidityand apraxia were common in both groups, but CBS-CBD patients were morelikely to have tremor (7/12 vs. 0/5, p � 0.04). Dysexecutive features, episodicmemory loss, visuospatial/perceptual and other parietal lobe deficits did notsignificantly differ between the two groups. Varying degrees of frontal andparietal atrophy and increased T2 and FLAIR signal changes on head MRI
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