Ignacio Demey

Estimulación y rehabilitación cognitiva en un centro ambulatorio: descripción y análisis de las variables iniciales

Resumen Introduccion La rehabilitacion cognitiva es una practica prescrita cada vez con mayor asiduidad en pacientes neurologicos con trastornos en sus funciones mentales superiores. Objetivo Describir las caracteristicas principales y efectuar un analisis comparativo de los puntajes obtenidos en diferentes escalas en pacientes que iniciaron tratamiento de estimulacion/rehabilitacion cognitiva en INEBA. Materiales y metodos Bateria de pruebas que incluyeron memoria episodica verbal, memoria subjetiva, actividades de la vida diaria, calidad de vida y rasgos depresivos. Descripcion y comparacion entre diferentes grupos etiologicos. Resultados Se analizaron los datos de 73 pacientes (38 varones y 35 mujeres; edad media: 59,89 anos [SD 19,42], educacion formal: media 13 anos [SD 3,74]). Dentro de la poblacion predominaron las causas vasculares (20 casos, 27%), los traumatismos encefalocraneanos (9 casos, 12%) y el deterioro cognitivo leve de causa no vascular (8 casos, 11%). En el analisis de los resultados de la bateria administrada se observo una diferencia significativa entre la percepcion subjetiva de memoria de los pacientes vasculares, con traumatismos y con deterioro cognitivo leve en algunas de las dimensiones estudiadas, entre ellas recuerdo de libros y peliculas, conversaciones y acciones a realizar. Conclusiones Se encontraron diferencias en la percepcion subjetiva de memoria entre los grupos considerados. Resulta importante dentro de los programas de rehabilitacion cognitiva considerar junto a la evaluacion del desempeno objetivo, aspectos metacognitivos y de creencias de memoria para asi conocer las fortalezas y debilidades del paciente de manera integral. Esto permitira el empleo de estrategias compensatorias que apunten a mejorar el desempeno funcional del paciente.

Argentina-Alzheimer's disease neuroimaging initiative (Arg-ADNI): neuropsychological evolution profile after one-year follow up

The Argentina-Alzheimers disease neuroimaging initiative (Arg-ADNI) study is a longitudinal prospective cohort of 50 participants at a single institution in Buenos Aires, Argentina. Longitudinal assessments on a neuropsychological test battery were performed on 15 controls, 24 mild cognitive impairment (MCI) patients and 12 Alzheimers disease (AD) dementia patients. In our study population, there was a high prevalence of positive AD biomarkers in the AD group, 92.3% (12/13); and a low prevalence in the normal controls, 20%; almost half (48%) of the patients diagnosed with MCI had positive amyloid detection. After a one year, the significant differences found at baseline on neuropsychological testing were similar at the follow-up assessment even though the AD group had significantly altered its functional performance (FAQ and CDR). The exception was semantic fluency, which showed greater impairment between the AD group and MCI and normal controls respectively. For these tests, the addition of AD biomarkers as a variable did not significantly alter the variations previously found for the established clinical groups model. Finally, the one-year conversion rate to dementia was 20% in the MCI cohort.

CORTICAL THICKNESS FOLLOW-UP AFTER ONE YEAR IN ADNI-ARGENTINA COHORT

P1-451 CORTICALTHICKNESS FOLLOW-UP AFTER ONE YEAR IN ADNI-ARGENTINA COHORT Ismael Luis Calandri, Ignacio Demey, Patricio Alexis Chrem Mendez, Gabriela Cohen, Maria Julieta Russo, Ezequiel Surace, Horacio Martinetto, Federico Nahas, Maria Eugenia Martin, Paula Harris, Jorge Campos, Gustavo Sevlever, Silvia Vazquez, Allegri F. Ricardo, Ra ul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina; Hospital Brit anico de Buenos Aires, Buenos Aires, Argentina; Ra ul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina. Contact e-mail: ismaelcalandri@gmail.com

RAPIDLY PROGRESSIVE DEMENTIA SECONDARY TO AUTOIMMUNE ENCEPHALITIS: NEUROPSYCHOLOGICAL PROFILES AND RESPONSE TO IMMUNOTHERAPY

P2-313 IS CUED RECALL OF SHARED AUTOBIOGRAPHICAL KNOWLEDGE USEFUL IN CLINICAL DEMENTIA ASSESSMENT? Claudia Frankenberg, Maren Knebel, Christina Degen, Nadeshda Andrejeva, Petra Wetzel, Lina Sidonija Gorenc-Mahmutaj, Sabrina Dominique Navratil, Inga Meyer-K€uhling, Britta Wendelstein, Johannes Schr€oder, Section of Geriatric Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Ageing Research, Faculty of Educational Sciences, Goethe University, Frankfurt am Main, Germany; Institute of Gerontology, University of Heidelberg, Heidelberg, Germany. Contact e-mail: Claudia.Frankenberg@med.uni-heidelberg.de

Influence of the affective valence of visual materials in recognition among healthy individuals and patients with Alzheimer's disease dementia

OBJECTIVE: To research into the influence of the affective valence of picture in visual recognition tests among healthy individuals and patients with mild Alzheimer’s Disease Dementia (ADD). BACKGROUND:Patients with Alzheimer’s disease (AD) present with impairments both at the structures associated with emotions, and in episodic memory. The involvement of the amygdala in patients with AD might imply emotional deficit in information processing. It has been reported that the impairment of patients with AD to perceive emotions might be lower than their deficit at the level of other cognitive functions, with a higher recalling of materials when the materials have emotional content. DESIGN/METHODS: Fifteen healthy individuals (age (mean±Standard Deviation) 73±8.48 years, education 13.2±3.9 years, Mini Mental State Examination (MMSE) 29.4±1.55), and 15 patients with ADD (age 75.47±7.61 years, education 10.8±4 years, MMSE 24.6±2.85), paired by age and education were included. Ten pictures with neutral valence and 10 pictures with negative valence were selected from the International Affective Picture System, paired by arousal level. Successful recognition of pictures and reaction time by picture valence were assessed by ANOVA test. RESULTS: A better performance was recorded both in terms of the number of successful recognition instances (F=1570;p=0.01) and of reaction time (F=285.40;p=0.01) in the control group compared to patients with ADD. Both groups evidenced a better recognition accuracy with negative-valence pictures than with neutral-valence pictures (F=4.66;p=0.04). CONCLUSIONS: A better performance of the control group was noted both in terms of processing rate and of recognition accuracy. In both groups, the recognition accuracy was higher with negative-valence prompts. These findings suggest that the emotional content of the information facilitates recognition. Disclosure: Dr. Irrazabal has nothing to disclose. Dr. Saux has nothing to disclose. Dr. Feldberg has nothing to disclose. Dr. Somale has nothing to disclose. Dr. Rojas has nothing to disclose. Dr. DEMEY has nothing to disclose.

Hippocampal mean diffusivity is a biomarker of neuronal injury in patients with mild cognitive impairment and Alzheimer’s disease dementia

OBJECTIVE: To analyze Mean Diffusivity in Magnetic Resonance Imaging (MD-MRI) at areas of the medial temporal cortex, both in healthy controls and in patients with degenerative amnesic Mild Cognitive Impairment (aMCI) and Alzheimer’s Disease Dementia (ADD). BACKGROUND: Different areas of the medial temporal cortex are usually involved in Alzheimer’s Disease (AD). MD-MRI measurements enable the analysis of water movements at tissue level, and increased diffusivity is associated with the presence of microstructure damages. DESIGN/METHODS: Forty-eight individuals (age 74.71±7.18 years) [16 healthy control individuals, 15 patients with aMCI, and 17 patients with ADD], right-handed, paired by age and education level were included in the study. The findings of MD-MRI among the different groups were analyzed at the level of the hippocampus, the Parahippocampal Gyrus (PG), and the Entorhinal Cortex (EC) with ANOVA (post-hoc Bonferroni test). These findings were correlated with their performance at the California Verbal Learning Test (CVLT), with Pearson test. RESULTS: MD-MRI right hippocampus measurements enabled the identification of 3 groups (ADD-controls: p<0.001, ADD-aMCI: p<0,05, aMCI-controls: p<0.05), with ADD patients presenting with the highest values, and patients with aMCI with intermediate results. Significant differences were noted at the left hippocampus between ADD-aMCI patients (p<0.01) and ADD-controls (p<0.001), without significant differences noted between controls and aMCI patients. Differences were also noted among the groups at the left PG (ADD-controls: p<0.05), left EC (ADD-controls: p<0.05), and right EC (ADD-controls: p<0.01). When analyzing the 3 groups as a whole, the 6 areas assessed showed significant negative correlations between MD-MRI values and patient performance in CVLT coding and delay recall tests. CONCLUSIONS: MD-MRI at these areas revealed differences among the 3 groups, thus reflecting the progressive microstructure damage present throughout the AD spectrum. These findings were also evidenced by patients9 performance at the episodic memory tests based on these structures. Disclosure: Dr. DEMEY has nothing to disclose. Dr. Ventrice has nothing to disclose. Dr. Rojas has nothing to disclose. Dr. Allegri has nothing to disclose. Dr. Zubiri has nothing to disclose. Dr. Somale has nothing to disclose.

Cognitive rehabilitation therapy after acquired brain injury in Argentina: Psychosocial outcomes in connection with the time elapsed before treatment initiation

Abstract Primary objective: To examine the effect of cognitive rehabilitation therapy (CRT) on psychosocial outcomes in Argentinean patients with acquired brain injury (ABI), in connection with the time elapsed between injury and treatment initiation. Research design: Self-reported data from patients in a naturalistic setting was collected before and after CRT. Methods and procedure: An outpatient sample of 75 Spanish-speaking patients with cognitive disturbances secondary to ABI (49 male/26 female, age: 50.2 ± 20.1 years; education 14.3 ± 3.2 years) completed a set of scales on their daily living activities, memory self-perception, quality-of-life and mood. Single and multi-group analyses were conducted, considering pre- and post- responses and the time elapsed between injury and treatment initiation. The influence of socio-demographic moderators was controlled during comparisons. Main results: Results suggest an improvement in several psychosocial indicators after treatment. Additionally, correlations and group comparisons showed greater improvement in subjective memory and quality-of-life self-reports in patients who began treatment earlier than those who began treatment after a longer time period. Conclusions: Overall, results suggest that CRT is associated with positive results in different areas of the psychosocial domain and that post-injury time can mediate this effect.

PREDICTORS OF CHANGE IN QUALITY OF LIFE IN PATIENTS WITH FOCAL NEUROLOGICAL DAMAGE FOLLOWING AN OUTPATIENT COGNITIVE REHABILITATION PROGRAM

OBJECTIVE: To evaluate the independent predictors of Quality of Life (QoL) change in patients with Focal Neurological Damage (FND) following an Outpatient Cognitive Rehabilitation (OCR) program. BACKGROUND: Few studies have analyzed the clinical and cognitive features associated with better outcomes in patients following an OCR program. DESIGN/METHODS: 90 patients (33 female, age: (mean ± SD) 51.27±19.68 years; education 14.51±3.37 years; Mini-Mental State Examination initial score 26.16±3.44) with cognitive impairment secondary to FND (60 cases with history of stroke, 22 cases of traumatic brain injury, 8 cases of other FND etiologies) were included. The subjects completed cognitive-behavioral, functional and social scales at baseline and treatment end. Efficacy, as measured by changes in the World Health Organization Quality of Life Brief Evaluation Instrument (WHOQOL-BREF), was evaluated by dividing the sample into 3 groups: benefit (difference >5 %), stability (difference between 5% and -5%), and worsening (difference >-5%). Categorical and quantitative predictors at baseline were analyzed prospectively. RESULTS: Based on the changes in the WHOQOL-BREF scale, 29 patients (32.2%) showed benefit, 45 (50%) showed stability, and 16 (17.8%) worsened after the OCR program. The predictors associated with benefit were: small number of sessions (p<0.05), lower score in the analogical visual scale (p<0.01), and poor score in the California Verbal Learning Test (CVLT) (p<0.05) and in direct span (p<0.01). The predictors associated with stability were: a better performance in the CVLT (p<0.01) and in direct span (p<0.01), and higher patient`s subjective memory score evaluated by the caregiver (p<0.01). The group that showed a worsening in QoL was associated to a higher Beck depression inventory score at baseline (p<0.01). CONCLUSIONS: In patients with FND following an OCR program, the analysis of independent predictors of QoL change may allow for a better prediction of treatment response. Study Supported by: Disclosure: Dr. Rojas has nothing to disclose. Dr. Leis has nothing to disclose. Dr. Ciufia has nothing to disclose. Dr. Saux has nothing to disclose. Dr. Feldberg has nothing to disclose. Dr. Caceres has received personal compensation for activities with Abbott, Serono Inc., and Teva Neuroscience as a speaker. Dr. Demey has nothing to disclose.

CORRELATION BETWEEN CORTICAL THICKNESS MEASUREMENTS FROM MAGNETIC RESONANCE IMAGING AND COGNITIVE PERFORMANCE ON EPISODIC AND SEMANTIC MEMORY TESTS

OBJECTIVE: To draw a correlation between the performance on Episodic Memory (EM) and Semantic Memory (SM) tests and Cortical Thickness (CT) measurements in healthy controls, patients with amnesic Mild Cognitive Impairment (aMCI) of degenerative etiology, and patients with Alzheimer’s disease (AD) dementia. BACKGROUND: CT measurements have been related to cognitive performance, and cortical thinning in regions of interest can be associated to lower scores in neuropsychological tests. EM and SM are different types of declarative, long-term memory, usually involved in AD. DESIGN/METHODS: 14 AD dementia patients (age: (median±SD) 76,29±8,74 years; education: 11,79±4,74 years) 10 aMCI patients (age:78,50±3,53 years; education: 11,40±4,00 years) and 7 healthy controls (age:73,43±8,22 years; education:12,86±5,24 years) were included. Raw scores on the coding and on the 20-minute delayed free-recall on the California Verbal Learning Test (CVLT) were used to measure EM performance, and raw scores on the Boston Naming Test (BNT) and on Semantic Fluency (FS) were used to measure SM performance, respectively. CT was measured with FreeSurfer. Correlations between patients’ raw scores and CT measurements were analyzed with Pearson´s correlation. RESULTS: Raw scores on the coding on the CVLT were positively correlated with left superior frontal gyrus (r:,356;p:,049) and with left parahippocampal gyrus (r:,449;p:,011) CT; raw scores on the 20-minute delayed free-recall on the CVLT with left parahippocampal gyrus (r,470;p:,008) and with circular sulcus of the insula (r:,422;p:,018) CT; raw scores on the BNT with left temporal pole (r:,580;p:,001) and with left inferior temporal sulcus (r:,496;p:,005) CT; and raw scores on FS with left middle temporal gyrus (r:,422; p:,018) and with right cingulate gyrus (r:,521;p,003) CT, among other significant results. CONCLUSIONS: Based on the results obtained in healthy controls, aMCI and AD dementia patients, the performance on EM and SM tests showed significant positive correlations with CT at several regions of interest. Study Supported by: Fundacion INEBA. Disclosure: Dr. Demey has nothing to disclose. Dr. Rojas has nothing to disclose. Dr. Somale has nothing to disclose. Dr. Ventrice has nothing to disclose.

REGIONAL BRAIN DIFFERENCES IN CORTICAL THICKNESS BETWEEN PATIENTS WITH AMNESTIC MILD COGNITIVE IMPAIRMENT AND ALZHEIMER'S DISEASE DEMENTIA

OBJECTIVE: To compare regional brain differences in Cortical Thickness measurements from Magnetic Resonance Imaging (CT-MRI) in patients with amnesic Mild Cognitive Impairment (aMCI) of degenerative etiology and Alzheimer`s Disease (AD) dementia. BACKGROUND: Patients with aMCI are considered to be in a prodromal state of AD, and show an increased risk of progression to AD dementia. Both β-amyloid deposition and Tau hyperphosphorylation are involved in the pathogenesis of AD, and may lead to synapse loss and neuronal death. CT- MRI measurements can detect cortical thinning and regional atrophy in these conditions. DESIGN/METHODS: The study population included 10 aMCI patients (5 female patients; age: (median±SD) 78,50±3,53 years; education: (median±SD) 11,40±4,00 years; Mini Mental State Examination (MMSE) score: (median±SD) 27,60±1,07), and 14 AD dementia patients (8 female patients; age: 76,29±8,74 years; education: 11,79±4,74 years; MMSE: 20,21±6,79), right-handed, matched for age and level of education. Cortical thickness (CT) was measured with FreeSurfer, and differences in patterns of reduced CT in the different patient groups were assessed using one-way ANOVA. RESULTS: Significant differences in CT measurements were found at different regions of interest and amongst the different patient groups. Compared to aMCI patients, patients with AD dementia showed cortical thinning at the posterior dorsal area of the cingulate gyrus (left) (F:5,866;p:,024); medial occipitotemporal sulcus (collateral sulcus), and lingual sulcus (left) (F:4,564;p,044); inferior precentral sulcus (left) (F:7,279;p:,013); inferior temporal sulcus (left) (F:7,769;p:,011); posterior transverse collateral sulcus (right) (F:4,288;p:,050); pericallosal sulcus (right) (F:6,411;p:,019), and inferior temporal sulcus (right) (F:5,727;p:,026). CONCLUSIONS: Patients with AD dementia showed cortical thinning at several cortical regions usually involved in the pathogenesis of AD. CT measurements may represent an inexpensive and widely available biomarker of cortical damage, useful in early diagnosis of AD as well as of other degenerative dementias. Study Supported by: Fundacion INEBA. Disclosure: Dr. Demey has nothing to disclose. Dr. Ventrice has nothing to disclose. Dr. Rojas has nothing to disclose. Dr. Somale has nothing to disclose. Dr. Allegri has nothing to disclose. Dr. Bevacqua has nothing to disclose. Dr. Lescano has nothing to disclose.