Poster Presentations P1 S161

53%), 6 (35%) were suspected of having VaDAND 2 (12%) were thought

to be related to systemic disease. Estimated dementia prevalence in those

over 60years of age showed large differences between urban (3%) and ru-

ral sites (7-16%), which were not explained by gender, ethnicity or socio-

economic status. However, rural areas are disproportionally populated by

older and less educated participants, who have less access to health care.

Healthier diets are also more likely to be consumed by the more affluent,

relatively younger Jakarta based population.Conclusions: These studies

showed that our short cheap and sensitive screening battery (15-20 min)

can be used for dementia screening in rural Java and possibly other de-

veloping countries.

P1-154 IS THERE A RELATIONSHIP

BETWEEN NONALCOHOLIC

FATTY LIVER DISEASE, THYROID

PATHOLOGYAND MILD COGNITIVE

IMPAIRMENT? A ROMANIAN

PROSPECTIVE STUDY

Ioana Ioancio1, Luiza Spiru2, Razvan Trascu3, 1Ana Aslan International

Academy of Aging, Bucharest; 2Ana Aslan International Academy of

Ageing, Bucharest; 3Ana Aslan International Academy of Ageing,

Bucharest.

Background: The mechanisms potentially responsible for accelerated

atherogenesis in nonalcoholic fatty liver disease (NAFLD) probably

originate in the expanded visceral adipose tissue, with the liver being

both the target of the resulting systemic abnormalities and a source of

proatherogenic molecules that amplify the arterial damage. NAFLD

has emerged as a growing public health problem worldwide. Increases

in morbidity and mortality due to cardiovascular disease are probably

among the most important clinical features associated with NAFLD.

Our prospective study investigated the link between NAFLD, thyroid

pathology and the risk to develop mild cognitive impairment (MCI).

Methods: The study included 83 patients (66.2% females, mean age

62.3 years), diagnosed with non-alcoholic fatty liver disease, referred to

the Memory Clinic in Bucharest; we assessed the incidences of co-mor-

bidities and cognitive diseases. Results: Over one third (38%) of patients

were obese and 72% met the diagnostic criteria of metabolic syndrome;

32.5% had MCI and 21.68% patients had different types of dementia.

The most frequent co-morbidities associated with NAFDL were: hyper-

tension (47.31%), diabetes mellitus (17.43%), thyroid pathology (14.94

%), hyperlypemia (33.2%), atherosclerosis (i.e. carotid stenosis and ob-

structive arterial disease - 8.3%). Anxiety and depression were detected

in 54.2% of patients. Conclusions: The association of NAFLD with car-

diovascular and thyroid disorders is a significant risk factor for the devel-

opment of MCI. These outcomes may have important impact on

prediction, prevention and early diagnosis of MCI. A multifactorial ap-

proach of the treatment of NAFDL is required, especially against cardio-

vascular and metabolic risk factors. Evaluation of the thyroid function is

also important as a powerful tool in the early diagnosis of cognitive im-

pairment in patients associating NAFDL.

P1-155 CLINICAL APPLICABILITY OF

EEG IN DIFFERENTIAL

DIAGNOSIS OF COGNITIVE

IMPAIRMENTAND DEMENTIA

G�ısli H�olmar J�ohannesson1, G�ısli J�ohannesson1, Kristinn Johnsen1,

J�on Snædal2, Halla Helgad�ottir1, Nicolas Blin1, �Asd�ıs Emilsd�ottir1,

Thorkell Gudmundsson2, 1Mentis Cura, Reykjavik; 2Mentis Cura,

Reykjavik; 2National University Hospital, Reykjavik.

Background:One of the main tasks in the diagnostic work up of cog-

nitive impairment and dementia is to differentiate between the various

causes but the current criteria for diagnosis of the most prevalent

forms of dementia are of different accuracy and up to 10% of cases

are difficult to diagnose with certainty (Knopman DS et al Neurology

2001;56:1143-53.) We present a diagnostic method which can provide

support for differential diagnosis into one of the following eight cat-

egories: Normal (NRM), Alzheimer’s disease (AD), stable Mild Cog-

nitive Impairment (stable for > 24 months ¼ sMCI), Progressive MCI

(converting to dementia within 24 months ¼ pMCI), Vascular Demen-

tia (VaD), Lewy-body/Parkinson’s (DLBP), depression (DPR) and

Frontal Lobe Dementia (FLD). Methods: 1050 EEG registrations

have been collected into an EEG database. All participants are in the

age range of 50 - 90 years. The individuals in the clinical groups were di-

agnosed at a memory clinic and the NRM individuals were sought from

the community. They were not demented and showed no signs of cogni-

tive impairment. Statistical pattern recognition (SPR) was used to create

classifiers using selected features from 1120 features of the EEG registra-

tion. For all binary comparisons of two distinct groups, a total of 28 com-

parisons, a numeric index from 0-100 was established to describe the

likelihood of an individual belonging to one of the two groups being com-

pared. Results: The diagnostic accuracy of the 28 comparisons all fall

within the range 73%-97%. The accuracy is estimated using ten-fold

cross validation. Thus it is possible to create a table with the results of

the 28 classifications and use it to predict which group a given individual

most likely belongs to. Clinical examples illustrate how this technique is

applied for differential diagnosis. Conclusions: Following a more sub-

stantial clinical validation and an easy access to the methodology, we ex-

pect this application of clinical EEG in support for differential diagnosis

of dementia to become a realistic first step in the full clinical workup of

patients with cognitive impairment and dementia. The underlying tech-

nology is well known, widely available and inexpensive in relation to

other imaging techniques.

P1-156 VISUALISING THE EMERGENCE

OF POSTERIOR CORTICAL

ATROPHY

Jonathan Kennedy1, Manja Lehmann2, Sebastian Crutch3, Nick Fox4,

Hilary A. Archer5, Magdalena Sokolska5, 1Dementia Research Centre,

London; 2University College London, London; 3University College London,

London; 4Dementia Research Centre, UCL Institute of Neurology, London;5University College London, London.

Background: Posterior cortical atrophy (PCA) is a progressive neurode-

generative condition characterized clinically by prominent impairments

of space perception, object perception, and other posterior cognitive func-

tions in the context of relatively spared episodic memory. We report the

emergence of PCA in a subject from a longitudinal study of subjective

memory complaints. Methods: Mr CE underwent annual assessments,

over 5 years, involving a clinical and neuropsychological assessment and

a volumetric T1-weighted MRI brain scan. MR images were segmented

and co-registered to provide whole brain atrophy rates were also using the

boundary shift integral. Non-linear registration of serial imaging to baseline

was performed producing voxel-compression maps in order to localise any

cerebral changes.Results:On his first visit CE, a 61 year-old man, reported

a 5 year history of difficulties with episodic memory but baseline neuro-

psychometry was normal. His initial MRI scan showed no atrophy or other

pathology. At visits 2 and 3 there was little change but by visit 4 he com-

plained of difficulty using an analogue watch and a tendency to lose his

place whilst reading. At visit 5 his symptoms had progressed and he now re-

ported difficulty ironing his shirts. Neuropsychological testing then revealed

a notable divergence between performance on tasks with and without a vi-

sual component. Visuospatial processing became impaired and visuoper-

ceptual processing deteriorated. Verbal memory tasks remained at average

or above whilst visual memory tasks became impaired or declined

Poster Presentations P1S162

throughout the study. Non-linear registration of his serial MR scans revealed

a posterior-anterior gradient of loss by visit 2, with early changes in inferior

temporal and superior parietal regions spreading later to affect the inferior

parietal and occipital lobes. A mean of the annual whole brain atrophy rates

across the study was 0.94% (normal age matched atrophy rate ¼ 0.32%).

Based on the young age of onset, progressive visual dysfunction and neuro-

imaging evidence of occipito-parieto-temporal atrophy, a diagnosis of PCA

attributable to probable AD was made. Conclusions: The present case rep-

resents a unique opportunity to study the clinical and neuropsychological

emergence of PCA. PCA may have a very focal onset but subtle cognitive

complaints and structural losses may precede even MCI criteria by some

years. Serial neuroimaging and neuropsychological assessment may aid al-

low earlier diagnosis when disease modifying treatments may be more

effective.

P1-157 THE AD8 INFORMANT INTERVIEW:

INFLUENCE OF CULTURAL BIAS ON

RELIABILITYAND DIAGNOSTIC

PERFORMANCE IN EARLY COGNITIVE

IMPAIRMENT (ECI)

Wee Shiong Lim1, Mei Sian Chong2, Peng Chew Mark Chan3, Laura Tay4,1Tan Tock Seng Hospital, Singapore; 2Tan Tock Seng Hospital, Singapore;3Tan Tock Seng Hospital, Singapore; 4Tan Tock Seng Hospital.

Background: Although widely regarded as being less susceptible to trans-

cultural factors than performance based screening measures, item adapta-

tion may be necessary when applying an informant based interview such

as the AD8 to a different cultural setting. We aim to ascertain the reliability

and diagnostic performance in ECI of the AD8 compared with culturally-

adapted versions in a memory clinic sample of predominantly Chinese eth-

nicity.Methods:We evaluated 339 patient-informant dyads, comprising 53

cognitively intact and 286 ECI subjects [40 with mild cognitive impairment

(MCI); 246 with early dementia (Clinical Dementia Rating 0.5-1.0)]. Using

a combination of clinical judgment, reliability tests and factor analysis, we

derive two modified 7-item versions: i) AD7-A: single item on planning, or-

ganization and problem solving replacing 2 items on executive function

(learning how to use gadgets or appliances, and problems with judgment);

and ii) AD7-B: as per AD7-A, but substituting item on disorientation to

timewith disorientation to place. We compared the factor structure, reliabil-

ity and ROC curve-derived sensitivity, specificity and AUC between AD8

and the two modified versions.Results: Factor analysis revealed an optimal

one-factor structure for all 3 versions, with degree of variance accounted for

by the single factor higher in the modified versions (52%) compared with

AD8 (49%). Despite being briefer than the AD8, the 7-item modified ver-

sions displayed higher reliability (Cronbach’s alpha: AD8 0.82, AD7-A

0.84, AD7-B 0.84). All 3 versions demonstrated good diagnostic perfor-

mance in ECI (AD8: Sn 82.7, Sp 90.2, AUC 0.93; AD7-A: Sn 90.2, Sp

82.4, AUC 0.93; AD7-B: Sn 83.5 Sp 90.2, AUC 0.94). When analyzed by

subgroups, there was no difference in diagnostic performance in early de-

mentia (AUC ¼ 0.96 for all 3 versions); however, both modified versions

had superior performance in MCI (AD8: Sn 54.3, Sp 80.4, AUC 0.74;

AD7-A: Sn 74.3, Sp 66.7, AUC 0.78; AD7-B: Sn 82.9 Sp 66.7, AUC

0.81). Conclusions: Certain items in the AD8 informant interview can be

susceptible to cultural bias. The resultant impact on its overall reliability

and diagnostic performance, especially in the MCI stage, can be mitigated

by modification of affected items.

P1-158 VALIDATION OF THE TURKISH

VERSION OF THE ADDENBROOKE’S

COGNITIVE EXAMINATION IN

TURKEY

EbruMihci1, Hakan Gurvit2, Basar Bilgic2, Hale Alpaslan2, Ayfer Tumac2,

Sinem Yildiz2, Pinar Unsalan2, Sukriye Akca Kalem2, Oget Oktem Tanor2,1Akdeniz University, Antalya; 2Istanbul University, Istanbul.

Background: Addenbrooke’s Cognitive Examination-Revised (ACE-R) is

a brief bedside cognitive screening test, which is shown to be specific and sen-

sitive instrument not only for the diagnosis of dementia but also mild cognitive

impairment (MCI). The aim of the present study was to validate the use of the

Turkish version of ACE-R.Methods:We applied the adapted Turkish version

of the ACE-R to 204 individuals comprising three groups: mild cognitive im-

pairment (MCI; n ¼ 45), mild Alzheimer’s disease (AD; n ¼ 83) and healthy

controls (HC; n ¼ 76). Total ACE-R score and subscores were statistically

compared statistically and sensitivity, specificity, area under curve (AUC)

and reliability were calculated. Results: The reliability of the ACE-R was

very good (a-coefficient 0.86). Overall the mean of the total ACE-Rscore of

the AD group (57.9615.3) was significantly different than the other 2 groups,

but comparable between the MCI (78.668.6)and HC (82.866.9) groups.

When only the highly educated (>11 years) male subgroups of the MCI and

HC groups were compared the difference became significant. We found that

the TurkishACE-R at cut-off point of 73 has a sensitivity of 92%and specificity

of 80% indiscriminating AD from a normal population with a perfect AUC and

at 69, the test has a sensitivity of 84% and a specificity of 75% in differentiating

MCI fromADwith a very goodAUC. The cutoff point of 88 has a sensitivity of

83% and a specificity of 100% indiscriminating male MCI patients with more

than11years of education from that of healthy controls with very good AUC.

Conclusions: TheTurkish version of theACE-R is a useful screening test for dis-

criminating demented patients fromnon-demented individuals. Its applicability in

the differentiation of MCI patients from cognitively normal elderly individuals

seems to be restricted into relatively high-educated males only. These findings

are largely in line with the previous non-English adaption studies of ACE-R.

P1-159 DEMENTIA AND DEPRESSION: TWO

EXISTING COMORBIDITIES

Hovhannes Manvelyan, Aleksandra Karapetyan, Avetis Avetisyan,

Hasmik Hambardzumyan, Astghik Karapetyan, Mikhail Aghajanov,

Yerevan State Medical Univeristy, Yerevan.

Background: Dementia and depression have tight interactions especially in

elderly. Patientswith early hallmark of dementia onset starting withMildCog-

nitive Impairment (MCI) often become depressed because of the overestima-

tion of memory deficit. Depression, or mood swings, anxiety, negative

emotions and stress are another often seeing conditions in elderly. Together

in clinical practice coexisting dementia and depression often could be omitted

or unintentionally misdiagnosed. Thus leads to wrong diagnosis and uneffec-

tive management Methods: 51 patient (30 women and 21 man, aged 72+/-

8) with dementia was selected for this study, all had cognitive impairment

from mild to severe and impaired activities of daily living. The inclusion cri-

teria were positive signs in clinical investigations, low scores on dementia

scales, will to cooperation and ability to understand the questions asked. All

patientswent through thoughtful evaluation by Folstein’sMMSE, BlessedDe-

mentia Scale, Hamilton and Beck’s Depression Scales. Results: We found

MCI in 24 patients (47%), the rest had more profound deficit. Positive signs