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Poster Presentations P1

Background: More than ten years ago it was validated and successfully used
an adaptation of the Boston naming test for South America (Allegri and cols,
1997). The same had been validated with information of the relatives or caregivers of patients. It presented limitations of low educational degree and lack of
aging patients (> 75 years) in the sample. Our objectives were to study the normative data of the Argentina Version for the Boston Naming test in a dwelling
extended population of normal subjects. To analyze the discriminative validity
for detect disorders of the language in patients with Alzheimer disease.
Methods: 210 normal adult subjects were selected between 20-93 years
old of the data base Argencog (Program of Baremizacion de Test Diagnoses
in the Area of Neurociencias Mental). Were selected 356 patients with probably Alzheimer disease (AD) and with vascular disease. Then was administered a test of language based on pictures that score in a range from 0 to
60. The sample was divided considering the age in 4 groups: < 55 (G1),
56-65 (G2), 66-75 (G3) y > 75 (G4). The groups were matched by age, education, and Beck Inventory. In addition, an analysis was performed according
to educational degree (primary school, high school and university). Positive
Predictive value (VPP) and negative (VPN) and positive likelihood ratio
(LR+) were calculated. Also Areas under the curve (AUC) with the ROC
method were obtained (Receiver Operator Characteristics). Results: In normal controls, were observed better performance in the Boston Naming Test
with higher educational level (r 0.43; p < 0.001) and less results in aging
subjects (r 0.50; p < 0.001). Differences between groups were confirmed
with the ANOVA test. Better Cut off point were calculated for all the groups
with AD; CDR mean 1.17 (0.62). Patients G2: AUC 0.97, cut off point 45
(sensitivity 96.2%; specificity 90.9%, LR+10.58). Patients G3:0.97, cut
off point 47 (sensitivity 96.6%; specificity 90.9; LR+10.62). Patients G4:
AUC 0.93, cut off point 40 (sensitivity 84.2%; specificity 87.5%;
LR+6.73). Conclusions: Normative data for a South American version of
the Boston Naming Test show an excellent discriminative validity. It present
as a useful diagnostic test for detection disorders of the language in AD. Losing sensitivity and specificity in elderly patients.

P1-467

GENETIC RISK AND COGNITIVE PERFORMANCE


IN THE WISCONSIN REGISTRY FOR
ALZHEIMERS PREVENTION (WRAP)

Mark Sager1, Rebecca Koscik2, Erin Jonaitis2, Asenath La Rue2,


Bruce Hermann3, 1University of Wisconsin, Madison, Wisconsin, United States;
2
Wisconsin Alzheimers Institute, Madison, Wisconsin, United States; 3UW
School of Medicine and Public Health, Madison, Wisconsin, United States.
Background: APOE e4 and family history of Alzheimers disease (AD) are
associated with higher risk of developing AD. Little is known about when
pre-clinical cognitive symptoms develop and whether differences can be detected in mid-life. The purpose of this study is to compare cognitive performance across family history and APOE risk groups in a middle-aged healthy
sample. Methods: Participants included 1362 adults (mean baseline age
53.6 6 6.6 years) enrolled in WRAP (72% parental history of AD, 40%
APOE e4 allele, 69% female, 93% non-Hispanic Caucasian). Participants
were administered a comprehensive neuropsychological battery at each of
up to 3 visits (28% 2 visits, 20% 3 visits). Summary z-scores were analyzed
for 4 cognitive domains derived from factor analysis of measures obtained
at all time points. Mixed models tested the significance of a 4-level family history/APOE risk variable (FH_APOE) and its interaction with test-retest interval, covarying baseline age, gender, education, and recruitment site; family,
participant ID, and the growth parameter for test-retest interval were included
as random effects when significant in their respective unconditional models.
Results: Immediate Memory, comprised of Trials 1 and 2 of the AVLT,
showed the greatest differences between risk groups with adjusted mean
z-scores of -.05 (FH+, e4+), -.04 (FH+, e4-), .04 (FH-, e4+), and .18 (FH-,
e4-; omnibus FH_APOE p .01). Both FH+ groups had lower Immediate
Memory scores than the FH-, e4- group. For Working Memory, the FH_APOE
by test-retest interval interaction was significant. Those in the FH+, e4+ group
had the worst profile (intercept at -0.346; annual change of -.004 z-scores)

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while the FH-, e4- group performed best (intercept of -.268; annual change
of .014 z-scores). No effect of FH_APOE was observed for Speed & Flexibility (p .42) or Verbal Learning & Memory (p .11). Conclusions: These
preliminary results suggest that cognitive differences may be emerging long
before clinical symptoms appear and that individuals with both a family history of AD and an APOE e4 allele may be at highest risk of early declines.
Follow-up is needed to determine whether current differences increase with
age and whether those with non-clinical deficits will develop MCI or AD.

P1-468

SEVERE MINI-MENTAL STATE EXAMINATION:


A BRIEF COGNITIVE ASSESSMENT FOR
PATIENTS WITH MODERATE AND SEVERE
DEMENTIA

Manuela Sales1, Claudia Suemoto1, Flavia Topciu1, Lilian Morillo1,


1
Universidade de Sao Paulo, S~ao Paulo, Brazil.
Background: About two thirds of demented patients are in moderate to severe
stages and live in developing countries. The most used screening tool available,
the Mini-mental State Evaluation (MMSE), has limited applicability in these
patients due to floor effects. The Severe Mini-Mental State Examination
(SMMES) is an instrument based on the original MMSE developed with the
objective of evaluating cognition in patients with more advanced Alzheimers
Disease. This study analyzed the correlation between the MMSE and the
SMMSE in the cognitive assessment of a sample with moderate and severe
dementia and the factors that interfered in this correlation. Methods: Transversal study of patients 60 years or older from an out-patient geriatric clinic at
University of Sao Paulo. Both MMSE and SMMSE were administered followed by patients charts search for health and demographics data. Possible
interference variables were gender, age, morbidity using the Charlson index,
dementia etiology, schooling, functionality, depression and other behavioral
symptoms, evaluated by Cornell depression scale and Neuropsychiatric Inventory (NPI). Results: 75 patients with mean age of 81 (SD 5.9) years,
65% female and mean schooling of 4 (SD 3.6) years. Mean scores on
MMSE and SMMSE were 7.8 (SD 7.0) and 17.8 (SD 9.4), respectively.
Performances on both scales were found to correlate significantly only for
scores on MMSE < 9 (r 0.87; p < 0.001). A strong correlation was also
found between the SMMSE and functional scales like de Clinical Dementia
Rating (p < 0.001), Functional Assessment Staging (< 0.001) and Activities
of Daily Living (p < 0.001). Educational level did not interfere with SMMSE
scores. In a linear regression model, correlation between MMSE and SMMSE
suffered little influence of FAST, ADL and NPI. Conclusions: Performances
on MMSE and SMMSE were found to correlate significantly only for scores
on MMSE < 9. Educational level did not interfere with scores on SMMSE.
Some factors like behavior and functionality seen to interfere with performance on this scale. The SMMSE is a useful instrument to be used for brief
cognitive assessment in patients with moderate to severe dementia, even in
samples from developing countries, where low educational level prevails.

P1-469

DYSEXECUTIVE SYNDROME IN SUBJECTIVE


COGNITIVE IMPAIRMENT

Nathalie Sambuchi1, Bernard Michel1, 1Alzheimers Disease Research


Group, Marseille, France.
Background: The concept of Mild Cognitive Impairment (MCI) had been
proposed by Petersen et al., (1999). The revised criteria (Petersen et al.,
2004) distinguished different sub types of MCI, simple or multiple domain,
amnestic (A-MCI) or non amnestic MCI. MCI could be a prodromic phase
of neurodegenerative disease, especially Alzheimers disease (AD). Another
concept concerns subjects with only memory complaint, without any cognitive
disturbances on memory tests. It has been called Subjective Cognitive Impairment (SCI) (Reisberg, 2009). SCI could precede MCI and AD of mean 15
years. Methods: In a cohort of 273 subjects, 24 normal controls (NC), 65
A-MCI, 117 SCI and 67 AD, consulting for memory complaint in

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