Rafaela Ávila

Clinical Applicability and Cutoff Values for an Unstructured Neuropsychological Assessment Protocol for Older Adults with Low Formal Education

Background and Objectives The neuropsychological exam plays a central role in the assessment of elderly patients with cognitive complaints. It is particularly relevant to differentiate patients with mild dementia from those subjects with mild cognitive impairment. Formal education is a critical factor in neuropsychological performance; however, there are few studies that evaluated the psychometric properties, especially criterion related validity, neuropsychological tests for patients with low formal education. The present study aims to investigate the validity of an unstructured neuropsychological assessment protocol for this population and develop cutoff values for clinical use. Methods and Results A protocol composed by the Rey-Auditory Verbal Learning Test, Frontal Assessment Battery, Category and Letter Fluency, Stick Design Test, Clock Drawing Test, Digit Span, Token Test and TN-LIN was administered to 274 older adults (96 normal aging, 85 mild cognitive impairment and 93 mild Alzheimer`s disease) with predominantly low formal education. Factor analysis showed a four factor structure related to Executive Functions, Language/Semantic Memory, Episodic Memory and Visuospatial Abilities, accounting for 65% of explained variance. Most of the tests showed a good sensitivity and specificity to differentiate the diagnostic groups. The neuropsychological protocol showed a significant ecological validity as 3 of the cognitive factors explained 31% of the variance on Instrumental Activities of Daily Living. Conclusion The study presents evidence of the construct, criteria and ecological validity for this protocol. The neuropsychological tests and the proposed cutoff values might be used for the clinical assessment of older adults with low formal education.

Development, validity, and reliability of the General Activities of Daily Living Scale: a multidimensional measure of activities of daily living for older people

OBJECTIVE To propose and evaluate the psychometric properties of a multidimensional measure of activities of daily living (ADLs) based on the Katz and Lawton indices for Alzheimers disease (AD) and mild cognitive impairment (MCI). METHODS In this study, 85 patients with MCI and 93 with AD, stratified by age (≤ 74 years, > 74 years), completed the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale, and their caregivers completed scales for ADLs. Construct validity (factor analysis), reliability (internal consistency), and criterion-related validity (receiver operating characteristic analysis and logistic regression) were assessed. RESULTS Three factors of ADL (self-care, domestic activities, and complex activities) were identified and used for item reorganization and for the creation of a new inventory, called the General Activities of Daily Living Scale (GADL). The components showed good internal consistency (> 0.800) and moderate (younger participants) or high (older participants) accuracy for the distinction between MCI and AD. An additive effect was found between the GADL complex ADLs and global ADLs with the MMSE for the correct classification of younger patients. CONCLUSION The GADL showed evidence of validity and reliability for the Brazilian elderly population. It may also play an important role in the differential diagnosis of MCI and AD.

A Reanalysis of Cognitive-Functional Performance in Older Adults: Investigating the Interaction Between Normal Aging, Mild Cognitive Impairment, Mild Alzheimer's Disease Dementia, and Depression

Depressive symptoms are associated with cognitive-functional impairment in normal aging older adults (NA). However, less is known about this effect on people with mild Cognitive Impairment (MCI) and mild Alzheimers disease dementia (AD). We investigated this relationship along with the NA-MCI-AD continuum by reanalyzing a previously published dataset. Participants (N = 274) underwent comprehensive neuropsychological assessment including measures of Executive Function, Language/Semantic Memory, Episodic Memory, Visuospatial Abilities, Activities of Daily Living (ADL), and the Geriatric Depression Scale. MANOVA, logistic regression and chi-square tests were performed to assess the association between depression and cognitive-functional performance in each group. In the NA group, depressed participants had a lower performance compared to non-depressed participants in all cognitive and functional domains. However, the same pattern was not observed in the MCI group or in AD. The results suggest a progressive loss of association between depression and worse cognitive-functional performance along the NA-MCI-AD continuum.

Increased N200 and P300 latencies in cognitively impaired elderly carrying ApoE ε‐4 allele

To compare the results of neuropsychological tests, evoked potentials N200 and P300 and polymorphisms of ApoE and BDNF rs6265 between patients with normal cognition and those with mild cognitive impairment (MCI) and Alzheimers dementia (AD).

Working Memory and Cognitive Flexibility Mediates Visuoconstructional Abilities in Older Adults with Heterogeneous Cognitive Ability.

Previous studies suggest that executive functions influence the performance on visuoconstructional tasks. This study aims to investigate whether the relationship between planning ability and the copy of complex figures is mediated by distinct components of executive functions (i.e., working memory, inhibitory control and cognitive flexibility). We included a 129 older adults with Alzheimers disease (n=36, AD), mild cognitive impairment (MCI, n=67), and with no evidence of cognitive impairment (controls, n=26). We evaluated the mediation effect of planning abilities, working memory, cognitive flexibility and inhibitory control on visuoconstructional tasks using a multiple mediation models. We found a significant direct effect of planning on visuoconstructional abilities and a partial mediation effect of working memory and cognitive flexibility on visuoconstructional abilities. The present results indicate that the performance on visuoconstructional task is mediated by multiple interrelated executive functions components, in particular working memory and cognitive flexibility.

STUDY OF CORRELATION BETWEEN BODY COMPOSITION AND THE ABSENCE OF OBJECTIVE COGNITIVE OR FUNCTIONAL IMPAIRMENT, MILD COGNITIVE IMPAIRMENT AND ALZHEIMER'S DEMENTIA

dementia subtypes and controls. Methods: 87 participants were recruited across three groups; 33 Alzheimer’s Disease (AD;(mean6sd) Age: 7867; MMSE: 2364), 27 Lewy Body Dementia (LBD; Age: 7867; MMSE: 2463) and 27 controls (Age:7469; MMSE: 2961). Dementia subtypes ranged from mild cognitive impairment to moderate dementia. A tri-axial accelometer (Axivity AX3) recorded data pertaining to gait and walking activity over 7 days. One way ANOVAs and non-parametric equivalents assessed group differences. Results: Preliminary results report significant gait impairments in both disease groups compared to controls for pace (step velocity, step length; (p .05)) and asymmetry (step, stance and swing time asymmetry (p .05); Figure 1). LBD alone were more variable in gait (step, stance, swing time and step velocity variability; (p .05)) compared to both AD and controls. People with LBD were also more variable than AD for step velocity (p 1⁄4 .021) and step length variability (p1⁄4 .041). LBD spent less time walking compared to controls and AD (p .05; Figure 2). AD took fewer average steps per day compared to controls (p1⁄4.019). LBD and AD were less variable in their walking bouts, and LBD performed a greater proportion of shorter walking bouts (higher alpha) compared to controls. Conclusions:Body-worn sensors provide an individualised representation of gait with information about discrete characteristics of gait impairment and changes in walking activity across all stages of cognitive impairment. This is important for both diagnostic and interventional purposes. Future research should aim to establish effects of environmental context on gait in free-living conditions to refine clinical interpretation.

RISK FACTORS FOR CONVERTING FROM MCI TO ALZHEIMER DEMENTIA IN A BRAZILIAN ELDERLY GROUP

P3-301 RISK FACTORS FOR CONVERTING FROM MCI TO ALZHEIMER DEMENTIA IN A BRAZILIAN ELDERLY GROUP Maria Aparecida Bicalho, Marco T ulio Cintra, Rafaela Avila, Ariane Fl avia Lage, Thayana Soares, Mônica Vieira Costa, Gesiane Thamire Tolentino Ara ujo, Nathalia Costa Vilaça, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; University Center Una, Belo Horizonte, Brazil; University Center Una, Belo Horizonte, Brazil. Contact e-mail: macbicalho@gmail.com

EFFECT OF BDNF VAL66MET AND APOE POLYMORPHISM ON COGNITION IN OLDER ADULTS

He initially illustrated the clinical manifestations of progressive nonfluent aphasia in 2011. However, he was finally diagnosed with AD presenting logopenic aphasia in 2013. The follow-up MRI scan showed progression of hippocampal trophy in comparison with the initial image. 3D protein structure modeling revealed that p.Val604Met exchange could result significant changes in the APP protein due to the increased hydrophobicity of methionine in the helix, which could result in alter the APP functions. Conclusions: Further clinical and biochemical studies with genetic analyses of family members would be needed to determine whether these mutations could be involved in AD progression and differentiations.

Functional decline in the elderly with MCI: Cultural adaptation of the ADCS-ADL scale

OBJECTIVE Translate, transcultural adaptation and application to Brazilian Portuguese of the Alzheimers Disease Cooperative Study - Activities of Daily Living (ADCS-ADL) scale as a cognitive screening instrument. METHOD We applied the back translation added with pretest and bilingual methods. The sample was composed by 95 elderly individuals and their caregivers. Thirty-two (32) participants were diagnosed as mild cognitive impairment (MCI) patients, 33 as Alzheimers disease (AD) patients and 30 were considered as cognitively normal individuals. RESULTS There were only little changes on the scale. The Cronbach alpha coefficient was 0.89. The scores were 72.9 for control group, followed by MCI (65.1) and by AD (55.9), with a p-value < 0.001. The ROC curve value was 0.89. We considered a cut point of 72 and we observed a sensibility of 86.2%, specificity of 70%, positive predictive value of 86.2%, negative predictive value of 70%, positive likelihood ratio of 2.9 and negative likelihood ratio of 0.2. CONCLUSION ADCS-ADL scale presents satisfactory psychometric properties to discriminate between MCI, AD and normal cognition.

AMNESTIC MILD COGNITIVE IMPAIRMENT: ASSOCIATED FACTORS WITH REMISSION TO NORMAL COGNITION IN A SAMPLE OF BRAZILIAN ELDERLY WITH LOW EDUCATIONAL LEVEL

interaction on DTI metrics, and significant models were stratified by SCD status. Results: SCD was not associated with NFL or any DTI metrics (p-values>0.05). DTI metrics were related to NFL (p-values<0.05). There were SCD x NFL interactions on DTI metrics within the longitudinal fasciculus, corona radiata, external and capsule (all p-values<0.05). Stratified analyses revealed that in SCD individuals, higher levels of NFL was related to decreased white matter integrity compared to non-SCD individuals (p-values<0.05). Conclusions: These results highlight an association between decreased white matter health and axonal injury in non-demented older adults that is exaggerated by SCD, an early marker of AD pathology. Results suggest a possible interplay between AD and cerebrovascular pathology that occurs early within the clinical manifestation of cognitive impairment. Individuals with SCD represent an ideal target for early prevention strategies. Test, MoCA and MMSE.