Yuriko Kato

Apathy is more severe in vascular than amnestic mild cognitive impairment in a community: the Kurihara Project.

The aim of this study was to estimate the prevalence of apathy, and to compare vascular mild cognitive impairment (vMCI), amnestic MCI (amMCI), and other type using Clinical Assessment for Spontaneity (CAS).

Disorders of "taste cognition" are associated with insular involvement in patients with Alzheimer's disease and vascular dementia: "memory of food is impaired in dementia and responsible for poor diet".

BACKGROUND In dementia patients, dietary intake problems may occur despite the absence of swallowing problems. We investigated cognitive functions on food and taste in Alzheimers disease (AD) and vascular dementia (VaD) patients. METHODS Participants included 15 healthy controls (HC), 30 AD and 20 VaD patients. Food Cognition Test: Replicas of three popular foods in Japan with no odors were presented visually to each participant, with the instruction to respond with the name of each food. Replicas of food materials were subsequently presented to ask whether they were included in these foods. Taste Cognition Test: Replicas of 12 kinds of foods were presented to describe their expected tastes. RESULTS The AD/VaD groups exhibited significantly lower scores on Food/Taste Cognition Tests compared with the HC group. These scores correlated inversely with Mini-Mental State Examination (MMSE) scores in the AD group. Decreased dietary intake was observed in 12 of the 50 patients; 8 of the 12 exhibited decreased Taste Cognition Test scores, higher than that of the normal-intake patients. There was no difference in the filter paper taste disc test between HC/AD/VaD groups. To test the hypothesis that the insula is associated with taste cognition, two MMSE-matched AD subgroups (n = 10 vs. 10) underwent positron emission tomography. Glucose metabolism in the right insula was lower in the low taste cognition subgroup. The VaD patients with insular lesions exhibited impaired Taste Cognition Test findings. CONCLUSIONS It is important to consider the cognitive aspect of dietary intake when we care for dementia patients.

A randomized controlled trial of psychosocial interventions for old-old people with mild cognitive impairment (MCI): Patient-reported outcomes—The Kurihara project

Background: Cognitive training is beneficial for patients with Mild Cognitive Impairment (MCI). However, more studies are needed to evaluate the longitudinal benefit yielded from the cognitive training. Patients with amnesic and multiple domains Mild Cognitive Impairment (aMCImd) were followed up after long-term participation in cognitive training. Methods: Participants were 87 aMCImd patients, classified in experimental and control groups, matched in age, gender, education, cognitive and functional performance. Results: At the follow up, there were significant differences in between-groups performance, with the experimental group performing higher in verbal (p€ı,£ .009) and visual memory (p1⁄4 .018), visual constructive abilities (p1⁄4 .018), language (p1⁄4 .026), executive function (p€ı,£ .014), global cognitive function (p1⁄4 .004), executive function in ADL (p1⁄4 .014) and ADL (p1⁄4 .003). Within-group analysis for the experimental group indicated improvement of attention, (p .009), verbal memory (p .010), visual memory (p1⁄4 .038), language (p1⁄4 .000). In contrast, the control group, showed deterioration in verbal memory (p€ı,£ .021), executive function (p€ı,£ .013), executive function in ADL. Conclusions: Longitudinal cognitive training helped aMCImd patients improve their cognitive performance, generalize the primary cognitive benefit to other cognitive domains and stabilize activities of daily living (ADL).

Normal Hearing Ability but Impaired Auditory Selective Attention Associated with Prediction of Response to Donepezil in Patients with Alzheimer's Disease.

Background. Alzheimers disease (AD) patients have a poor response to the voices of caregivers. After administration of donepezil, caregivers often find that patients respond more frequently, whereas they had previously pretended to be “deaf.” We investigated whether auditory selective attention is associated with response to donepezil. Methods. The subjects were40 AD patients, 20 elderly healthy controls (HCs), and 15 young HCs. Pure tone audiometry was conducted and an original Auditory Selective Attention (ASA) test was performed with a MoCA vigilance test. Reassessment of the AD group was performed after donepezil treatment for 3 months. Results. Hearing level of the AD group was the same as that of the elderly HC group. However, ASA test scores decreased in the AD group and were correlated with the vigilance test scores. Donepezil responders (MMSE 3+) also showed improvement on the ASA test. At baseline, the responders had higher vigilance and lower ASA test scores. Conclusion. Contrary to the common view, AD patients had a similar level of hearing ability to healthy elderly. Auditory attention was impaired in AD patients, which suggests that unnecessary sounds should be avoided in nursing homes. Auditory selective attention is associated with response to donepezil in AD.

A randomized controlled trial of psychosocial interventions for old-old people with mild cognitive impairment (MCI): Physical and neuropsychological outcomes—The Kurihara project

Background: Cognitive training is beneficial for patients with Mild Cognitive Impairment (MCI). However, more studies are needed to evaluate the longitudinal benefit yielded from the cognitive training. Patients with amnesic and multiple domains Mild Cognitive Impairment (aMCImd) were followed up after long-term participation in cognitive training. Methods: Participants were 87 aMCImd patients, classified in experimental and control groups, matched in age, gender, education, cognitive and functional performance. Results: At the follow up, there were significant differences in between-groups performance, with the experimental group performing higher in verbal (p€ı,£ .009) and visual memory (p1⁄4 .018), visual constructive abilities (p1⁄4 .018), language (p1⁄4 .026), executive function (p€ı,£ .014), global cognitive function (p1⁄4 .004), executive function in ADL (p1⁄4 .014) and ADL (p1⁄4 .003). Within-group analysis for the experimental group indicated improvement of attention, (p .009), verbal memory (p .010), visual memory (p1⁄4 .038), language (p1⁄4 .000). In contrast, the control group, showed deterioration in verbal memory (p€ı,£ .021), executive function (p€ı,£ .013), executive function in ADL. Conclusions: Longitudinal cognitive training helped aMCImd patients improve their cognitive performance, generalize the primary cognitive benefit to other cognitive domains and stabilize activities of daily living (ADL).

Lifetime Expectancy in Dementia with Lewy Bodies: Effects of Donepezil Administration and Special Nursing Home Replacement. A Retrospective Analysis in the Tajiri Project

Objective: Cholinesterase inhibitors (ChEIs) can delay the progression of Alzheimer disease (AD). We previously demonstrated a positive effect of donepezil (DNP) administration and a Special Nursing Home (SNH) replacement on lifetime expectancy after the onset of AD. Recently DNP has been indicated for use in the treatment of dementia with Lewy Bodies (DLB); however, the effect on lifetime expectancy remains unclear. Herein, we analyzed the effects of DNP on DLB. Methods: All outpatients at the Tajiri Clinic with available medical records and death certificates from 1999- 2012 were included in this retrospective analysis. The entry criteria were a diagnosis of dementia based on DSM-IV criteria and diagnosis of DLB using the international consensus criteria; medical treatment for more than 3 months and follow up to less than 1 year before death. Results: We identified 510 subjects based upon medical records and death certificates, of which 360 had a diagnosis of dementia that met the entry criteria. Of 51 patients diagnosed with DLB, 23 had taken DNP and 28 patients had not undergone drug treatment due to treatment prior to the introduction of DNP in 1999 in Japan. The lifetime expectancies after onset were 6.4 years in the DNP group and 3.6 years in the non-DNP group; with a significant drug effect. However, in contrast with the previous AD data, no significant effect of SNH residency was noted. Conclusion: Although this report has the limitation that all analyses were retrospective and lacked randomization, we found a positive effect of DNP on lifetime expectancy after the onset of DLB. The lower life expectancy compared with that of AD and the lack of an effect of SNH residency suggest the cholinergic deficiency in DLB is greater than that in AD.

MONITORING OF DRUG TREATMENT AND PSYCHOSOCIAL INTERVENTION WITH THE EZIS SYSTEM ( 99M TC-ECD SPECT) FOR AD PATIENTS: THE OSAKI-TAJIRI PROJECT

P2-418 METHODOLOGICAL AND LOGISTIC STRATEGIES FOR A LARGE MULTICENTER b-AMYLOID PET EUROPEAN PROJECT: AMYLOID IMAGING TO PREVENTALZHEIMER’S DISEASE (AMYPAD) Juan Domingo Gispert, Chris Foley, Adriaan A. Lammertsma, Bart N. M. van Berckel, Maqsood M. Yaqub, M. Jorge Cardoso, Pawel Markiewicz, Marc Modat, Chris J. Buckley, Anja Mett, Santiago Bullich, Nigel Banton, Elisabetta Grecci, John Hall, Derek L. Hill, Pierre Payoux, Alexander Drzezga, Craig W. Ritchie, Mark E. Schmidt, Gill Farrar, Frederik Barkhof, Barcelonabeta Brain Research Center, Barcelona, Spain; GE Healthcare, Amersham, United Kingdom; Neuroscience Campus Amsterdam, Amsterdam, Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, Netherlands; Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands; Translational Imaging Group, Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, UCL, London, United Kingdom; Translational Imaging Group, UCL Centre for Medial Image Computing, London, United Kingdom; Piramal Imaging GmbH, Berlin, Germany; Piramal Imaging, Havant, United Kingdom; IXICO PLC, London, United Kingdom; IXICO, London, United Kingdom; Universit e de Toulouse, Toulouse, France; University Hospital Cologne, Cologne, Germany; University of Edinburgh, Edinburgh, United Kingdom; Janssen Research and Development, Beerse, Belgium; Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom. Contact e-mail: jdgispert@fpmaragall.org

BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD) IN ALZHEIMER DISEASE IS “COGNITIVE” SYMPTOMS? THE OSAKI-TAJIRI PROJECT

MINT (68) 62 (2.1) 61 (3.3) 59 (4.0) 60.8 (2.4) 45.2 (8.5) 0.01y Nouns denomination (16) 15.6 (0.5) 12.4 (6.3) 15.6 (0.8) 15 (0.7) 7.4 (6.4) 0.04y Verbs denomination (16) 13.3 (2.8) 10.4 (15.9) 13 (1.8) 13.2 (0.8) 4.4 (5.3) 0.04y Northwestern Anagrams (10) 9.6 (0.6) 9.4 (0.8) 10 (0) 6.4 (3.7) 0 <0.01y Sentence’s lecture (5) 4.9 (0.3) 5(0) 5(0) 4.8 (0.4) 1.8 (1.6) 0.017y Sentences’s repetition (5) 5(0) 5(0) 4.6 (0.5) 4.8 (0.4) 1.2 (1.6) <0.01y Animals semantic fluency 19.4 (4.9) 19 (6.8) 17.8 (3.2) 15.2 (6.6) 6.2 (3.7) 0.018y Vegetables semantic fluency 13.2 (4.3) 12.8 (3.6) 11.4 (3.0) 10.4 (4.8) 3.6 (1.5) 0.020y Phonological fluency letter M 11.6 (2.8) 11.4 (5.6) 14.2 (3.7) 10.4 (5.4) 2 (1.2) 0.019y Phonological fluency letter P 11.2 (4.1) 12.4 (8.1) 17.2 (2.5) 14.2 (7.9) 2.8 (1.3) 0.013y Semantic word picture matching test (20) 19.8 (0.6) 19.2 (1.7) 19.8 (0.4) 19.8 (0.4) 18 (1.4) 0.043y

OLDER RESIDENTS CANNOT OPERATE WELL THE INDUCTION HEATING (IH) COOKERS DUE TO EXECUTIVE DYSFUNCTION: THE WAKUYA PROJECT

Background:Handling errors with household flammables, such as pan burning, may result in serious accidents. The accidents were caused by a decrease in attention or executive function. Themanual for the elderly with dementia of several cities simply suggests the use of Induction Heating (IH) cookers in cases of increased risk of fire. However, the IH cooker contains the complicated button operation and thus may be difficult for older residents to handle. Methods: We examined 105 residents aged 65 years or older in Wakuya, northern Japan, consisted of 57 Clinical Dementia Rating (CDR) 0 (healthy), 41 CDR 0.5 (very mild dementia), and 7 CDR 1+ (dementia) participants. The use rate of IH (Induction Heating) appliance was 29% in the CDR 0 group and 24 % of the CDR 0.5 group. We asked the participants to actually use the IH cooker. Using or without the manual of the cooker, the participants who passed all the procedures were classified as “Good Users,” whereas those failed any procedures were classified as “Poor Users.” Their global cognitive and executive functions were assessed using the Mini-Mental State Examination (MMSE), and Trail Making Test A (TMT-A) and Digit Symbol (DS), respectively. Results: The ratio of “Good Users” in the CDR 0, CDR 0.5, and CDR 1+ groups were 23 (40.4%), 7 (17.1%), and 0 (0%), respectively. For the CDR 0 group, the Good Users had higher scores on the MMSE, TMT-A, and DS compared to the Poor Users (p<0.05). As for the CDR 0.5 group, the Good Users showed higher scores on the DS (p<0.05) compared to the Poor Users. Conclusions:Since the IH cooker contains the complicated button operation, they may be difficult for older residents to handle. Executive function may be more likely to be involved in handling errors with household flammables.

Donepezil can prolong lifespan in Alzheimer's disease: The Tajiri Project 1999-2012

Background: The differential diagnosis of mood disorder with associated dementia-like symptoms (pseudodementia) or Alzheimer disease (AD) may be difficult. Although the Mini Mental State Examination (MMSE) and magnetic resonance imaging (MRI) are used as diagnosis for dementia, they cannot adequately identify pseudodementia or AD. We studied that the effectiveness of VSRAD (Voxel-Based Specific Regional Analysis System for Alzheimer’s Disease) in differentiating between mood disorder and AD. Methods: The subjects consisted of 75 patients with pseudodementia or AD (mean age 73.467.01 years, average Z score 1.81 61.18, average MMSE score 22.73 65.43). They were divided into three groups, that is, the mood disorder group (n1⁄433), the AD group (n1⁄430) and the mood disorder group of later development of AD (n1⁄412). We compared the MMSE and degree of parahippocampal gyrus atrophy as a Z score of the VSRAD to MRI data between the three types of dementia. Moreover, Receiver operating characteristic (ROC) curve analysis was used to calculate the cut-off value of a Z score in differentiating between mood disorder and AD.Results: There are correlations between theMMSE and a Z scores, the Z scorewas highly in the group that had a lowerMMSE score. The mood disorder group had significantly lower Z scores than the AD group (p < 0.001). The mood disorder group had significantly lower Z scores than the mood disorder group of later development of AD (p <0.001). The cut-off value of a Z score between the mood disorder group and the AD group was 1.52(sensitivity of 91.67% and specificity of 84.85%), there is a high possibility of AD when a Z score is higher than 1.52. The cut-off value of a Z score between the mood disorder group and the mood disorder group of later development of AD was 1.32, there is a high possibility of mood disorder of later development AD when a Z score is higher than 1.32. Conclusions: It is suggested that VSRAD is an effective auxiliary diagnosis for differentiating between mood disorder with associated dementia-like symptoms and Alzheimer disease, and make it possible to learn the risk of Alzheimer’s disease onset in mood disorder.