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A BSTRACTS
findings suggest that early control of elevated blood pressure may
promote successful brain aging.
A133 Encore Presentation
A Driving Assessment Clinic: Structure and Statistics.
S. Suraj, G. Madero, M. Shawn, N. Shirley. Geriatrics Department,
Marshall University, Huntington, WV.
OBJECTIVE: The decision whether a patient of advanced age
or with a diagnosis of dementia should stop driving is a complex one,
as there are no firm guidelines. Clinicians do not generally provide
uniform assessments; indeed they rarely do any formal assessment to
decide the answer for each patient. At the Hanshaw Geriatric Center
we reviewed records of the patients from our Driving Assessment
clinic to find whether any general recommendations can be made for
Primary Care Physicians to assist them in planning for driving assessments
for their patients.
PATIENTS AND METHODS: Records where reviewed from
all patients evaluated at our Driving Assessment Clinic at the Hanshaw
Geriatric Center from August 2007 to mid 2010. We first assessed
patterns of appointments themselves (kept/cancelled/“noshowed”),
and subsequently reviewed actual assessment results.
RESULTS: Out of 144 appointment slots available, 109 (76%)
were filled. 26 (24%) of 109 appointments were Cancelled out of
which 16 (62%) rescheduled and were evaluated. 14 (13%) of 109
were “No Shows” out of which 1 (7%) rescheduled and was evaluated.
A total of 49 patients (29 men and 19 women) where evaluated,
3 of whom underwent the testing twice, for a total of 52 evaluations.
Mean age was 75.4. The prevalence of CNS disorders was high
among those tested. In 27 evaluations (52%), the patient had the diagnosis
of dementia at the time of the assessment. Eleven (21%) had
suffered head trauma, four of whom also had a dementia diagnosis.
Nine (17%) had strokes. In two cases, all three diagnoses coexisted,
yet the patients were still driving.
CONCLUSIONS: In spite of the value of having objective data
about our patients’ driving skills, in is difficult to obtain such data.
Formal driving assessment is labor intensive and cancellation and noshow
rates are quite high. We conclude that this is not a process which
can be accomplished in the primary care office, nor even in many
larger institutions. Regional assessment clinics are a possible approach,
but would likely have to be supported by funds other than
fee-for-service.
A134
Identifying the malady of synaptic plasticity-related genes in human
Alzheimer’s Disease.
S. M. Harvey, J. Knebl, J. Simpkins, S. Sarkar. University of North
Texas Health Science Center, Fort Worth, TX.
Early Alzheimer’s disease (AD) pathophysiology is characterized
by synaptic changes induced by degradation products of amyloid
precursor protein (APP). Although there is evidence for synaptic dysfunction
induced by soluble oligomeric Aβ, the pre- or postsynaptic
sites of action and the specific mechanisms responsible for such dysfunction
have not been established. We reasoned that by measuring
pre-and postsynaptic plasticity related gene expression in different
brain regions from age matched control (AMC) and AD patients,
candidate defective gene(s) by the criteria of severe loss of expression
in AD could be identified. Preliminary results from western blot
analysis show region specific severe loss of expression of pre-synaptic
proteins AP-180, synaptogamin and dynamin in AD compared to
AMC. These losses were most profound in the occipital and temporal
cortices, but not significant in the cerebellum. The loss of expression
of pre-synaptic protein molecule could lead to defects in synaptic
function and ultimately to synapse loss that underlies the memory impairment
evident in the early phase of AD.
A135
Defining Dementia Multimorbidity in a National Sample.
T. Sadak, J. Katon, S. Borson. University of Washington, Seattle, WA.
Supported By: JAHF Atlantic Philanthropies Claire Fagin
Fellowship
National Alzheimer’s Diseases Coordinating Center
Background: Clinicians cite clinical complexity as a major challenge
in caring for dementia patients, and no general model of care
has found wide acceptance. Quantifying clinical complexity is a first
step toward developing the necessary infrastructure for populationbased
dementia care. Our goal was to describe dementia multimorbidity,
using prevalence estimates for single and complex dementia
etiologies, neuropsychiatric symptoms (NPS), and co-morbid chronic
psychiatric and medical conditions in a large, systematically diagnosed
national sample.
Methods: Baseline visit data in the National Alzheimer’s Coordinating
Center repository [U01 AG016976] were analyzed for 3851
persons enrolled in an Alzheimer’s Disease Research Center
(ADRC) and diagnosed with one of the four most common primary
dementias (Alzheimer’s (AD), Lewy Body (DLB), behavioral variant
Frontotemporal (BvFTD), and Vascular (VaD)). ‘Complex dementia’
was defined as >1 concurrent etiologic diagnoses; severity
was indexed by the clinical dementia rating (CDR). Co-morbid conditions
(present or absent) included cardiovascular disease (CVD),
cerebrovascular disease (CVAD), diabetes, hypertension (HTN), hypercholesterolemia
(HCL), and primary psychiatric disorders. NPS
were rated using the total NPI-Q score (prevalence X severity
summed across 12 symptoms). Results: The sample prevalence of primary
dementia diagnoses was 3338 for AD, 241 for DLB, 189 for
bvFTD, and 83 for VaD. Overall, 202 persons (5%) had >1 etiology.
Dementia was mild (CDR 1) in 64% of the sample. Almost all patients
(93%) had at least one additional clinical problem; 89% had a
comorbid chronic medical condition and 27% had ≥3. 41% had a psychiatric
diagnosis (nearly all depression), and 88% had at least one
current NPS, with total NPIQ scores varying by dementia etiology
(AD 5.4, DLB 8.7, bvFTD 9.3, VaD 7.0). Severe dementia (CDR 3+)
was more prevalent among persons with complex etiologies (17%)
compared to those with a single etiology (11%, p < 0.05) and mean
NPIQ scores were higher (7.5 vs. 5.8, p < 0.05).
Conclusions: Multimorbidity is part of the reality of dementia,
even among participants in ADRC’s, where the prevalence of ‘pure’
AD is higher and overall clinical complexity is expected to be lower
than in an unselected population. This study points to the need for
conceptual and pragmatic approaches to care that incorporate complexity
and its impact on clinical outcomes.
A136
Reliability of the Rey Complex Figure Test for Identifying Mild
Cognitive Impairment.
T. V. De Beritto, 1 K. D. Tingus, 2 P. H. Lu, 2 E. Teng. 2,3 1. University of
Utah School of Medicine, Salt Lake City, UT; 2. Neurology, UCLA,
Los Angeles, CA; 3. VA Healthcare System, Los Angeles, CA.
Supported By: MSTAR (Medical Student Training in Aging
Research Grant)
Background: Individuals meeting criteria for mild cognitive impairment
(MCI) progress to dementia at higher rates than agematched
controls. However, the optimal operationalization of the
MCI criteria remains uncertain. The Rey Complex Figure Test
(RCFT) is widely used to assess memory and visuospatial functioning.
Previous work indicates that the RCFT has good sensitivity for
identifying cognitive impairment, but RCFT deficits are unstable.
This study explores potential factors limiting the utility of the RCFT
for identifying MCI.
Methods: We identified 182 participants who met criteria for
MCI (n=106) or normal cognition (NC; n=76) and had been assessed
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AGS 2012 ANNUAL MEETING