Here - American Geriatrics Society
Here - American Geriatrics Society
Here - American Geriatrics Society
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P OSTER<br />
A BSTRACTS<br />
C141<br />
Contribution of brain imaging to the understanding of Alzheimer<br />
disease-related gait disorders, a systematic review.<br />
C. Annweiler, 1,2 O. Beauchet, 2 R. Bartha, 3 M. Montero-Odasso. 1 1.<br />
Department of Medicine, Division of Geriatric Medicine, The<br />
University of Western Ontario, London, ON, Canada; 2. Department<br />
of Internal Medicine and <strong>Geriatrics</strong>, Angers University Hospital,<br />
Angers, France; 3. Center for Functional and Metabolic Mapping,<br />
Robarts Research Institute, London, ON, Canada.<br />
Background. Although Alzheimer disease-related gait disorders<br />
(ADRGD) are common, determining their origin is a goal yet to be<br />
reached. In particular, which brain structures and underlying lesions<br />
are involved in ADRGD remains unknown. Our objective was to systematically<br />
review all published data that examined the associations<br />
between gait disorders and brain imaging in patients with Alzheimer<br />
disease (AD).<br />
Methods. We conducted a Medline and Cochrane Library search<br />
indexed under the MeSH terms “Gait” OR “Gait Disorders, Neurologic”<br />
OR “Walking” combined with “Brain Mapping” OR “Magnetic<br />
Resonance Imaging” OR “Tomography, X-Ray Computed” OR “Tomography,<br />
Emission-Computed, Single-Photon” OR “Positron-Emission<br />
Tomography” OR “Nuclear Medicine” OR “Brain” combined<br />
with “Alzheimer disease” OR “Dementia”.<br />
Results. Of the 465 selected studies, 3 observational studies met<br />
the selection criteria. The number of participants ranged from 2 to 42<br />
community-dwelling AD patients (29% to 100% female). ADRGD<br />
(i.e., shorter stride length) were associated with a high visual score of<br />
white matter lesions, mainly in the medial frontal lobes and basal ganglia.<br />
The nigrostriatal dopamine system was unaffected. Finally,<br />
ADRGD (i.e., shorter stride length and higher stride length variability)<br />
correlated with lower hippocampal volume and function.<br />
Conclusions. ADRGD could be explained by a high burden of<br />
subcortical hyperintensities on the frontal-subcortical circuits together<br />
with hippocampal atrophy and hypometabolism.<br />
C142<br />
Does the Veterans Affairs Saint Louis University Mental Status<br />
(SLUMS) Exam predict the course of cognitive impairment?<br />
D. M. Cruz, 1 C. M. Allen, 1 T. K. Malmstrom, 1 N. Tumosa, 1,2 J. E. Morley<br />
. 1 1. <strong>Geriatrics</strong>, Saint Louis University, St. Louis, MO; 2. GRECC, St<br />
Louis VAMC Jefferson Barracks Division, Saint Louis, MO.<br />
Supported By: No financial disclosure.<br />
Background: The Veterans Affairs Saint Louis University Mental<br />
Status (SLUMS) exam is a screening tool developed for the detection<br />
of cognitive impairment which showed better sensitivity and<br />
specificity for the detection of both dementia and mild cognitive impairment<br />
(MCI) than the Mini-Mental State Exam (MMSE). This<br />
study explores the SLUMS exam’s potential to identify the clinical<br />
course of MCI and dementia in patients with cognitive impairment<br />
after 7.5-years.<br />
Methods: Patients (N=533) at the Geriatric Research, Education<br />
and Clinical Center at the Veterans Affairs Hospital St. Louis,<br />
MO were screened for cognitive dysfunction in 2003 using both the<br />
SLUMS exam and the MMSE. In 2010 the rates of mortality, institutionalization<br />
and change in SLUMS exam score were evaluated as<br />
outcome measures. In this longitudinal study the associations between<br />
outcome measures, MMSE and SLUMS exam total scores, individual<br />
item scores, and cognitive status were examined using Kaplan-Meier<br />
curves and Cox proportional-hazards regression.<br />
Results: Five hundred thirty three charts were reviewed:<br />
176/533(33%) patients had died and 31/526 (6%) were institutionalized<br />
during the 7.5-year follow-up period. All subjects were male,<br />
with a mean age of 75 years, and most had high school education or<br />
greater (71%). MMSE dementia and SLUMS exam dementia<br />
(p34%) was found among stroke caregivers.<br />
To understand caregiver depression, we investigated depression<br />
risk factors among stroke patients and their caregivers.<br />
Method: In the national telephone survey for stroke caregivers’<br />
experience,we indentified caregivers ofVeterans who had the first-time<br />
stroke during 2000 and 2006. The level of depression was measured by<br />
the 10-item CESD scale.The social support measure was the sum of 12<br />
items. Bivariate analyses identified significant risk factors with depression.<br />
Adjusting for covariates, logistic regression was applied to assess<br />
the relationship between social support and depression; and ordinal repeated<br />
measure analysis was used to test for interaction effects between<br />
social support and race on 10 items of depression scale simultaneously.<br />
Results: Among 261 caregiver-Veteran dyads, there were 62%<br />
whites, 17% blacks, and 21% Puerto Ricans caregivers (mean<br />
age=65). An increased likelihood of being depressed was found in the<br />
following caregivers’ characteristics (p values ranged from
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