Memory Disorders Clinic Research Articles

Suspected Pseudobulbar Affect in Neurodegenerative Disease.

To investigate the association between suspected pseudobulbar affect (PBA), clinical diagnosis, cognitive testing, and self-reported mood in older adults presenting for evaluation of dementia. Patients presenting to an outpatient memory disorders clinic (N=311). We used traditional and novel network modeling approaches to examine associations between neuropsychological (NP) tests, patient and clinician rating scales, and the Center for Neurological Study-Lability Scale (CNS-LS) among patients with suspected AD (n=133) and other neurocognitive diagnosis (n=178). We then examined differences in test performance between patients with and without suspected PBA (CNS-LS cut-off of ≥ 13), while accounting for demographic and psychiatric covariates with propensity score matching. Group differences were assessed with Bayesian models. Prevalence of suspected PBA in AD was slightly less than half (44.4%) and at a similar rate in other dementias (e.g., 46.9% in CVD and 45.5% in LBD). In network models, the CNS-LS was associated with higher anxiety and better word list recall. After accounting for covariates, AD patients with suspected PBA performed better on word list recall βM=0.40, 95% CI [0.15, 0.66], and committed fewer false positive errors on recognition βM=-1.51, 95% CI [-2.34, -0.59] than AD patients without suspected PBA. There were no differences in patients with any other diagnostic impression, nor group differences on other NP measures. Patients with suspected PBA and AD diagnosis had better memory recall and recognition than those without suspected PBA, suggesting that impaired emotional regulation may be an early sign of AD in patients with less prominent memory decline. Better understanding PBA in neurodegenerative diseases, including prevalence and comorbidity with psychiatric conditions, could help with early identification, education, and initiation of treatment.

A - 93 How Normal Is Normal? Comparison of “within Normal Limits” Patients in a Memory Clinic with Cognitively Healthy Community Volunteers

Abstract Objective Among patients who present for evaluation at a Memory Disorder Clinic (MDC), a small number are found to have “cognition within normal limits” (WNL). The fact they sought an evaluation suggests WNL may overstate their level of functioning. We compared performance on a brief neurocognitive battery of a recruited sample of healthy older volunteers (HV) to a WNL group from an MDC. Methods 183 HVs with MoCA score ≥ 25 (M age = 75.07, SD = 5.60; 73% female) and 178 (MDC) patients diagnosed WNL (M age = 77.08, SD = 6.62; 53% female) were administered the Shepherd Verbal Learning Test (SVLT; Gifford & Webbe, 2008); the TOMM; a shortened version of the BNT (MACK-SF4); and the Trailmaking Test (TMT-A&B). Results Independent-samples t-tests revealed that HVs had significantly better TMT A & B scores than WNL patients: (M = 33.23, SD = 11.69) vs. (M = 41.19, SD = 15.76), p < 0.001 and (M = 88.98, SD = 35.20) vs. (M = 115.96, SD = 59.61), p < 0.001, respectively. HVs also had significantly better MACK-SF4 scores than WNL (M = 14.31, SD = 1.15) vs. (M = 13.28, SD = 2.27), p < 0.001. No significant group differences were found among SVLT or TOMM scores. WNL was slightly older and less well-educated. Conclusion TOMM scores for both groups were above 47, suggesting good effort. Both HVs and WNL patients performed equally well on all SVLT measures. HVs scored significantly better in Trail-making and confrontational naming, suggesting that in WNL executive function and language might be less than “normal.” These mixed outcomes suggest that WNL performance at a Memory Clinic may still fall short of true normal.

Long Term Cognitive Impact of Electroconvulsive Therapy in Patients with Early Frontotemporal Lobar Degeneration

Frontotemporal lobar degeneration (FTLD) is the umbrella term to describe several overlapping neurodegenerative syndromes including progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and behavioral variant frontotemporal dementia (bvFTD). Most patients with FTLD present initially with psychiatric symptoms such as apathy, depressed mood, and fatigue (often with a mild Parkinsonism) that almost always prove refractory to medication interventions and psychotherapy. Some patients may be recommended for electroconvulsive therapy (ECT), which in our clinical experience, is not effective and potentially harmful. Electroconvulsive therapy has a well-known risk of cognitive impairment and memory loss but the full impact and long-term effects of this intervention are not well studied in individuals with neurodegenerative disease.For this clinical case presentation, we will discuss the case of a 69-year-old left-handed female who presented to our memory and cognitive disorders clinic after several years of apathy, depressed mood, and irritability. Due to the refractory nature of her treatment, she had undergone several rounds to ECT; an intervention that did not help her behavioral symptoms and appeared to accelerate her cognitive decline. Volumetric MRI and neuropsychological testing confirmed the diagnosis of corticobasal degeneration, a FTLD spectrum disease. Implications for course and management of this patient's neurodegenerative process, particularly neuropsychiatric sequelae, will be discussed.

Examining the Plasma Ab42/40 Ratio in the Context of Memory Disorder Clinics

Examining the Plasma Ab42/40 Ratio in the Context of Memory Disorder Clinics

The Use of Event Related Potentials to Predict Amyloid PET Status Among Patients from a Memory Disorders Clinic.

Amyloid positron emission tomography (PET) scans provide in vivo evidence of Alzheimer's disease (AD); however, their high cost limits their use in standard clinical care. Event related potentials (ERPs) may represent an inexpensive and non-invasive additional method for detecting AD pathology. We investigated whether ERPs, along with neuropsychological data, serve as predictors of amyloid PET status in patients with memory complaints. Veterans aged 50-100 were recruited from a memory disorders clinic. Participants underwent a neuropsychological battery and an ERP auditory oddball protocol. Twenty-eight patients had a positive amyloid PET scan, and thirty-nine patients had a negative scan. ERP-P200 target amplitude and P200 standard latency were predictors of amyloid PET status. When submitting to ROC analysis, P200 standard latency exhibited the highest specificity and sensitivity in predicting amyloid PET positivity, correctly classifying the amyloid PET status for 86% of patients. ERP-P200 measures are strong indicators of amyloid-β presence in patients from a memory disorder clinic. Increased P200 amplitude and decreased P200 latency in patients with a positive amyloid PET scan may be attributed to hyperactivation of perceptual bottom-up processes compensating for AD-related synaptic loss in the fronto-parietal networks.

Screening for Cognitive Impairment in Movement Disorders: Comparison of the Montreal Cognitive Assessment and Quick Mild Cognitive Impairment Screen in Parkinson's Disease and Lewy Body Dementia.

The Montreal Cognitive Assessment (MoCA) is recommended by the Movement Disorder Society for cognitive testing in movement disorders including Parkinson's disease (PD) and lewy body dementia. Few studies have compared cognitive screening instruments in these diseases, which overlap clinically. To compare the MoCA and Quick Mild Cognitive Impairment (Qmci) screen in this population. Patients attending memory and movement disorder clinics associated with a university hospital had the MoCA and Qmci screen performed and diagnostic accuracy compared with the area under the receiver operating characteristic curve (AUC). Duration and severity of movement disorders was assessed using the Unified PD Rating Scale (UPDRS). In total, 133 assessments were available, median age 74±5. Median education was 11±4 years and 65% were male. Median total UPDRS score was 37±26. Median Qmci screen was 51±27, median MoCA was 19±10. There were statistically significant differences in test scores between those with subjective symptoms but normal cognition, mild cognitive impairment (MCI) and dementia (p < 0.001). The Qmci screen had significantly greater accuracy differentiating normal cognition from MCI versus the MoCA (AUC 0.90 versus 0.72, p = 0.01). Both instruments had similar accuracy in identifying cognitive impairment and separating MCI from dementia. The median administration time for the Qmci screen and MoCA were 5.19 and 9.24 minutes (p < 0.001), respectively. Both the MoCA and Qmci screen have good to excellent accuracy in a population with movement disorders experiencing cognitive symptoms. The Qmci screen was significantly more accurate for those with early symptoms and had a shorter administration time.

EXAMINING CAREGIVER NETWORK STRUCTURE, COMPOSITION, AND COORDINATION FOR OLDER ADULTS WITH ALZHEIMER’S DISEASE

Abstract Over half of the older adults with Alzheimer’s disease and related dementias (ADRD) live in the community with informal caregivers whose unpaid assistance constitutes the majority of their care. Research and interventions targeting caregivers typically limit their focus to one primary caregiver, but many older adults with ADRD rely on a variety of interconnected kin, non-kin, and professional supporters. Little is known about the structure, composition, or consequences of these caregiver networks. To address this gap, we conducted a social network analysis (SNA) of the caregiver networks of 23 older adults with ADRD receiving outpatient services at a Memory Disorder Clinic. SNA data was obtained through detailed social network interviews conducted one-on-one with self-identified primary caregivers. We find that adults with ADRD have an average of 7.7 caregivers in their networks. Quantitative analyses demonstrate that caregiver network properties (including size, density, composition, and care coordination) vary with the context of caregiving (including living situation, level of functional impairment, and use of formal services). An average network includes a roughly even mix of informal caregivers (3.2 members) and professional caregivers (3.5), but they occupy different network positions and fill distinct supportive roles. For example, informal caregivers engage in frequent care coordination, but coordination is comparatively uncommon between formal caregivers. This interdisciplinary research advances beyond the dyadic level of analysis typical of most caregiving research to comprehensively measure caregiver networks. Further, we identify variations in caregiver networks and quantify network-based task-sharing and care coordination among informal and professional caregivers.

The use of Event Related Potentials to predict amyloid PET status among patients from a memory disorders clinic

AbstractBackgroundAmyloid PET scans provide in vivo evidence of Alzheimer’s Disease (AD) however, due to high cost and limited insurance coverage, they are not available as part of standard clinical care. Event Related Potentials (ERPs) are inexpensive, and non‐invasive method to directly measure brain physiology that may allow an alternative method for detection of AD pathology.MethodWe investigated whether ERPs together with neuropsychological data are predictors of amyloid PET status in patients with memory complaints. Older veterans aged 50‐100 were recruited from a memory disorders clinic at VA Boston Healthcare System. Participants underwent a standard neuropsychological battery and an ERP auditory oddball protocol. Twenty‐eight patients had a positive amyloid PET scan, and thirty‐nine patients had a negative amyloid PET scan.ResultsTwo neuropsychological measures (CERAD Delayed Recall and MMSE) were predictors of amyloid PET status. Increased P200 target amplitude (Figure 1B), and decreased P200 standard latency (Figure 1A) in patients with amyloid PET positive scan were found. ERP‐P200 amplitude in response to target tones and ERP‐P200 latency in response to standard tones were also predictors of amyloid PET status. The highest classification accuracy was obtained when combining CERAD Delayed Recall, MMSE and ERP‐P200 standard latency.ConclusionERP‐P200, especially when combined with cognitive measures of delayed memory and overall cognitive function, was predictive of amyloid beta (Aβ) load in the brain of patients from a memory disorder clinic. Increased P200 amplitude, and decreased P200 latency in patients with amyloid PET positive scan might suggest hyperactivation of perceptual bottom‐up processes to compensate for AD‐related synaptic loss in the fronto‐parietal networks.

Correlation between longitudinal changes of clinical symptoms and striatal DAT uptake in DLB

AbstractBackgroundIt is widely known that there is low striatal 123I‐FP‐CIT dopamine transporter single photon emission tomography (DaT‐SPECT) uptake in patients with dementia with Lewy bodies (DLB). There are no study about the association between longitudinal changes of clinical sign and DaT‐uptake in Parkinson syndrome, especially in DLB. The aim of this study is to investigate the association between the longitudinal changes of DaT uptake and severity of parkinsonism and cognitive funtion in DLB.MethodA total of 35 outpatients with probable DLB who underwent DaT‐SPECT twice (initial and follow up period) from the Memory Disorder Clinic at the Department of Geriatric Medicine, Tokyo Medical University, were enrolled in this study from April 2014 until September 2020. We examined the correlation between annual changes of DaT uptake and symptoms (cognitive function decline, parkinsonism) in the patients with DLB.ResultThere was significant correlation between annual changes of severity of parkinsonism and DAT uptake in left posterior putamen (r = ‐0.39, p = 0.03), MMSE scores and DaT uptake in the entire regions except right posterior putamen (P&lt; 0.05) in patients with DLB.ConclusionThese results may suggest clarifying the mechanism of dysfunction of nigrostriatal projection pathway in DLB.

The relationship between Event‐Related Potentials and MRI cortical atrophy in a memory disorders clinic

AbstractBackgroundThere is a need for accessible and affordable ways to assess biomarkers of Alzheimer’s disease (AD). Event‐related potentials (ERPs) are associated with disease severity of AD (Fruehwirt et al., 2019) and are a candidate biomarker for AD (Olichney et al., 2022). There is, however, little understanding of how ERP components relate to neurodegeneration of specific brain structures in AD.MethodWe investigated the correlation between electrophysiology, as measured by ERPs and brain structure using quantitative structural MRI measurements using FreeSurfer. A dataset containing older veteran memory disorders patients (N = 25) from VA Boston Healthcare System was analyzed. Participants completed an MRI and an auditory oddball task ERP paradigm.ResultAn exploratory analysis was performed using a Pearson correlation coefficient to evaluate the relationship between ERPs and the thickness and volume of different cortical areas. There was a negative relationship between P300 target amplitude and inferior temporal volume (p &lt; .05), as well as P300 target latency and thickness of the superior temporal (p &lt; .05) and transverse temporal regions (p &lt; .01). P200 standard amplitude had a positive correlation with thickness in the middle temporal (p &lt; .01), and superior temporal regions (p ≤ .05), and P200 target latency had a negative correlation with thickness of the superior temporal region (p &lt; .05). N200 target amplitude had a negative correlation with the superior parietal volume (right hemisphere = p ≤ .05, left hemisphere = p ≤ .01), left inferior temporal volume (p ≤ .05), and the middle temporal volume (left = p ≤ .05, right = p ≤ .01). N200 target latency was negatively correlated with right superior parietal volume (p ≤ .05).ConclusionA correlation was found between ERP measures P200, N200 and P300 with cortical thickness and volume of areas that are commonly impacted by AD pathology, further substantiating use of ERPs as possible AD biomarkers. We conclude that ERPs provide insights as to structural changes of brain structures affected by AD pathology. ERPs could help inform areas of brain atrophy and related patterns of cognitive impairment.

3 Are we Up-Front About Switching or are we Side-Stepping the Issue: Localization of Cognitive Switching Measures with Cortical Thickness

Objective:Set-shifting/switching tasks, among other measures of executive functioning, are typically thought to represent frontal lobe functioning. However, the neuroanatomical correlates of these tests are not fully established. The aim of this study was to examine associations between individual measures of set-shifting/switching and cortical thickness. We hypothesized that performance on each switching measure would strongly correlate with aggregated cortical thickness within the frontal lobe.Participants and Methods:Measures of interest included set-shifting subtests of the Delis-Kaplan Executive Function System (DKEFS): Color-Word Inhibition Switching, Category Switching, and Trail Making Test Number-Letter Switching. Archival data from an outpatient memory disorders clinic were reviewed to identify individuals whose neuropsychological evaluations included the measures of interest and had quality-assessed, volumetric MRI data available (n=243; 53.1% male, 81.9% Caucasian, Mage=72.4, SDage=6.7). Cortical thickness values were generated by FreeSurfer and averages were calculated for both frontal and temporal lobes, separately. Using partial correlations, controlling for age, we explored associations between each switching trial separately with right and left, frontal and temporal cortical thickness. The strength of associations within each lobe were then compared using Fisher's r-to-z transformations.Results:Category Switching was significantly correlated with left and right hemisphere temporal thickness (r=0.38 and 0.31, respectively), but was not significantly correlated with left or right frontal lobe cortical thickness (r=.12 and .07, respectively). Fisher's r-to-z transformations revealed significantly stronger relationships between Category Switching and temporal thickness, rather than frontal thicknesses. Trails Switching was also significantly correlated with left and right temporal cortical thickness (r=-0.28, and =-0.23, respectively) and bore weaker associations with frontal cortical thickness (r=-.13 and r = -.14 for left and right hemispheres, respectively). In contrast, Color-Word Inhibition-Switching did not show a significant relationship with frontal or temporal cortical thickness.Conclusions:Contrary to our hypothesis, stronger associations were observed with temporal lobe cortical thickness for Category Switching. Category Switching involves a language production component which could explain the strong association with temporal cortical thickness compared to frontal cortical thickness. Additionally, the pattern of associations between Trails Switching and frontal and temporal thickness was non-specific. Perhaps most striking is the lack of association between each switching measure and frontal cortical thickness, which was unexpected, given that these measures are used to assess executive functioning, broadly localized to the frontal lobe. Future directions involve examining the associations of these measure with subcortical structures and replicating these findings in larger datasets.

Association between longitudinal changes in striatal dopamine transporter uptake and clinical features of dementia with Lewy bodies.

It is widely known that there is low striatal 123 I-2β-Carbomethoxy-3β-(4-iodophenyl)-N-(3- fluoropropyl) nortropane (123 I-FP-CIT) dopamine transporter single photon emission tomography (DaT-SPECT) uptake in patients with dementia with Lewy bodies (DLB). No studies to date have analyzed the association between longitudinal changes of clinical features and DaT uptake in patients with Parkinson syndrome, particularly those with DLB. The aim of this study was to investigate the association between the longitudinal changes in DaT uptake and the severity of parkinsonism and cognitive function in DLB patients. A total of 35 outpatients with probable DLB who underwent DaT-SPECT twice (at the initial examination and the follow-up period) in the Memory Disorder Clinic at the Department of Geriatric Medicine, Tokyo Medical University, were enrolled in this study between April 2014 and September 2020. The correlation between annual changes in DaT uptake and clinical features (cognitive function decline and parkinsonism) of the patients was analyzed. A significant correlation was detected between annual changes in parkinsonism symptom severity and DaT uptake in the left posterior putamen (r = -0.39, P = 0.03), and between Mini-Mental State Examination scores and DaT uptake in all regions except the right posterior putamen (P < 0.05) in patients with DLB. Our results suggested that the pathway from the ventrolateral tier of the substantia nigra to the putamen might be more crucial for motor function than other pathways, not only in Parkinson's disease but also in DLB.

Amyloid PET ordering practices in a memory disorders clinic

AbstractBackgroundThe objective of the current study was to assess amyloid PET scan ordering practices in a Veterans Affairs memory disorders clinic, where such scans are readily available, and the extent to which amyloid PET ordering may occur in memory disorders clinics if covered by insurance in the future.MethodsUsing retrospective chart review over a three‐year period, we compared patient demographic, clinical, and MRI structural features that were predictive of ordering an amyloid PET scan in a memory disorders clinic to those of patients who did not have one ordered. The percentage of patients who met previously published appropriate use criteria were evaluated.ResultOverall 34.9% of patients received an amyloid PET scan as part of their diagnostic workup and 97.9% of these ordered scans were consistent with appropriate use criteria. Patients who received an amyloid PET were younger on average and more likely to have an initial diagnosis of suspected AD. Overall, 64.4% of patients without an amyloid PET scan ordered would have met appropriate use criteria for amyloid PET. Thus, fewer patients received an amyloid PET scan than were eligible according to current appropriate use criteria.ConclusionA little more than a third of veterans in a memory disorders clinic received an amyloid PET scan as part of their diagnostic work up when ordering was freely available to cognitive behavioral neurologists and not constrained by third‐party reimbursement. The vast majority of amyloid PET scans ordered were consistent with current appropriate use criteria. Future versions of the appropriate use criteria for amyloid PET could address ordering in patients with subjective cognitive decline with behavioral/functional impairments as well as patients under consideration for possible anti‐amyloid therapy treatment with Aducanumab and other medications in this class.

The association between electrophysiological and neuropsychological measures and cardiovascular disease in patients with Alzheimer’s Disease dementia

AbstractBackgroundElectrophysiological and neuropsychological measures are useful markers of Alzheimer’s Disease (AD); however, it is still unclear how these measures relate to the cardiovascular profile of AD patients, and their influence on disease progression and management. Our study examined how electrophysiological and neuropsychological measures are associated with cardiovascular risk factors and the severity of small vessel disease among patients with AD dementia.MethodData were collected using a seven‐electrode COGNISION™ rig in 185 older veterans from the VA Boston Healthcare system memory disorders clinic. EEG/ERP data were recorded while participants completed a three‐tone auditory oddball task. All subjects were administered a neuropsychological battery composed of 8 subtests. Through review of medical history, we selected a subset of patients (N = 46) that met the following criteria: core clinical criteria for probable AD dementia, ≥ 65 years of age, and MMSE score between 20 and 26. We categorized these patients based on their number of cardiovascular risk factors—among hypertension, type 2 diabetes or prediabetes, hypercholesterolemia, and body mass index (BMI) ≥ 25 kg/m2 —and their small vessel disease severity (absent, mild, moderate, or severe). Spearman correlations were computed to assess the association of electrophysiological and neuropsychological measures with the number of cardiovascular risk factors and the severity of small vessel disease.ResultAlpha peak frequency was positively correlated with the number of cardiovascular risk factors (p = .011) and was inversely correlated with small vessel disease severity (p = .029). N100 standard latency was inversely correlated with small vessel disease severity (p = .018). Scores on the verbal phonemic fluency test were inversely correlated with the number of cardiovascular risk factors (p = .014), while scores on the verbal category fluency test were inversely correlated with small vessel disease severity (p = .023).ConclusionAlpha peak frequency, N100, and verbal fluency scores are associated with the number of cardiovascular risk factors and small vessel disease severity in AD patients. Overall, these electrophysiological and neuropsychological measures represent a clinical tool to help characterize the cardiovascular profile of patients with AD dementia, and its contribution to overall disease progression.

Creation of a Memory Disorders Clinic Biorepository to Characterize a Clinic Population and Accurately Refer to Research Studies (P2-6.006)

<h3>Objective:</h3> 1) To build a biorepository of blood samples from a memory disorders clinic population, 2) To make samples available to Alzheimer’s Disease and Related Dementias (ADRD) researchers, 3) To further characterize the samples with plasma biomarkers <h3>Background:</h3> The Duke University Memory Disorders Clinic receives requests from researchers for participants from our clinic population and enrolls patients in clinical trials. Results of demographic and clinical information, genetic testing and plasma biomarkers will characterize patients for referral to research studies with increased accuracy. <h3>Design/Methods:</h3> We approach Duke Memory Disorders Clinic patients to contribute a blood sample for ADRC research. Staff processes and stores the sample. A portion is banked at the National Centralized Repository for Alzheimer’s Disease and Related Dementias (NCRAD). NCRAD performs APOE testing free of charge and returns results to Duke. Staff enters patient demographics and clinical information from the EHR into a REDCap database. Information from REDCap including APOE status is gathered in a publicly viewed secure web-based platform developed at Duke called the Alzheimer’s disease RElational and iNtegrated dAtaset (ARENA). Researchers at Duke and outside institutions can request samples or participants. <h3>Results:</h3> We collected samples from 115 patients. Patients continue to be enrolled. Demographics include 85% white participants, 11% black participants, 4% other race/unknown; 56% female; 55% with family history of Alzheimer’s disease or dementia; average age 76. Diagnoses include 40% mild cognitive impairment; 27% clinical Alzheimer’s disease; 24% dementia; 14% normal cognition; 3% subjective cognitive impairment. Average MoCA score is 20. The rate of APOE 4 status is overall 53% with 5% APOE 2/4, 38% APOE 3/4, 10% APOE 4/4. <h3>Conclusions:</h3> The rate of APOE4 in the biorepository is higher than in the general population. The biorepository provides a rich source of APOE4 samples and participants for research. In the future, we will evaluate plasma-based biomarkers (NfL, Aβ40/42, p-tau). <b>Disclosure:</b> Dr. Johnson has nothing to disclose. Mr. Perry has nothing to disclose. The institution of Dr. Parker has received research support from NIH. Dr. Liu has received personal compensation in the range of $0-$499 for serving as a Consultant for Darwin Research Group. Ms. Beam has received personal compensation in the range of $500-$4,999 for serving as a Faculty for Cognitive Assessment Toolkit with AAPA/PA Foundation. Ms. Sanfilippo has nothing to disclose. The institution of Dr. Lutz has received research support from NIH. Dr. O’Brien has nothing to disclose.

Impact of Medication Optimization and Recommendations by Clinical Pharmacists Embedded in a Memory Disorder Clinic (P3-7.005)

<h3>Objective:</h3> The purpose of this study is to determine the impact of pharmacist recommendations on reduction of potentially inappropriate medications (PIMs) in an older adult population with dementia or mild cognitive impairment (MCI). <h3>Background:</h3> Older adults with dementia or MCI are particularly vulnerable to adverse effects from PIMs. Many PIMs are anticholinergic medications which have been correlated with development of cognitive impairment in older adults. Previous studies have demonstrated that pharmacist interventions may reduce PIMs in older adults, but the impact of pharmacists embedded in an outpatient memory care clinic has not been adequately studied. <h3>Design/Methods:</h3> This prospective interventional study within an outpatient neurology center included patients at least 65 years old and diagnosed with dementia or MCI. Pharmacists utilized the American Geriatrics Society Beers Criteria, the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions, and the Anticholinergic Burden Scale (ACB) to identify PIMs and made recommendations to prescribers when appropriate based on clinical judgement. Primary outcomes included frequency and prevalence of PIMs before vs. after pharmacist intervention and rate of acceptance of pharmacy recommendations. Additional outcomes included ACB scores before vs. after intervention. <h3>Results:</h3> A total of 180 patients were included. Pharmacists made recommendations for 49% of patients. Common pharmacist recommendations included laboratory monitoring, medication discontinuations or substitutions. Out of 192 total pharmacist recommendations, 61 (32%) were accepted by providers within the neurology center’s memory clinic. After pharmacist intervention, the frequency and prevalence of PIMs as well as ACB scores were significantly reduced (p &lt; 0.01). <h3>Conclusions:</h3> Pharmacist intervention resulted in a significant reduction in PIMs and ACB scores in patients with dementia or MCI. Future studies should incorporate a prospective design to examine the clinical benefit of pharmacist intervention and explore additional methods to improve multidisciplinary collaboration between pharmacists and prescribers. <b>Disclosure:</b> Dr. Mattle has nothing to disclose. Miss Coli has nothing to disclose. Miss Lee has nothing to disclose. Dr. Aladeen has nothing to disclose. Dr. Ajtai has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Rainka has stock in Abbvie. Dr. Rainka has stock in acadia. Dr. Rainka has stock in alon. Dr. Rainka has stock in biogen. Dr. Rainka has stock in bristol myers squib. Dr. Rainka has stock in eisai. Dr. Rainka has stock in Lilly. Dr. Rainka has stock in novartis. Dr. Rainka has stock in pfizer. Dr. Rainka has stock in roche. Dr. Rainka has stock in Sage. Dr. Rainka has stock in alkermes.

Identifying mixed Lewy body and Alzheimer’s disease pathologies using functional neuroimaging (P6-12.002)

<h3>Objective:</h3> To distinguish between Alzheimer’s disease, Lewy body dementia and Parkinson’s disease using functional neuroimaging. <h3>Background:</h3> Lewy body dementia (LBD) and Alzheimer’s disease (AD) are the two most common neurodegenerative causes of dementia. Autopsy studies report many cases with these clinical diagnoses having mixed pathology with alpha-synuclein, tau and amyloid proteinopathies. There is limited research in trying to distinguish these potential mixed pathology conditions prior to death. <h3>Design/Methods:</h3> 43 subjects were recruited from Ohio State University Memory Disorder and Movement Clinics. Subjects were diagnosed based on standard clinical criteria for DLB, PD and AD by fellowship trained cognitive and movement disorders faculty. Cognitive testing performed included MMSE and SAGE. We used neuroimaging methods including FDG PET, amyloid PET, and DaTscan SPECT to evaluate subjects diagnosed with dementia with Lewy bodies (DLB), AD and PD to investigate how often potential mixed pathologies could be present. The neuroimaging evaluations were blinded to clinical diagnosis. <h3>Results:</h3> 28 subjects with clinical diagnosis of Lewy body disease (15 DLB and 13 PD) and 15 subjects with clinical diagnosis AD were compared. The Lewy body subjects were 69.5 ± 7.2 years old, MMSE 26.6 ± 4, and SAGE 18.4 ± 4.7. AD subjects were 68.4 ± 9.3 years old, MMSE 16.3 ± 6.4, and SAGE 7.4 ± 6.1. 5 subjects (33%) of the clinical AD cases showed abnormal DAT scan uptake, 3 subjects (20%) of the clinical AD cases were negative for amyloid with normal DaTscan uptake, 3 subjects (20%) of the clinical DLB cases showed mixed LBD and AD features, 2 subjects (13%) of the clinical DLB cases were positive for amyloid with normal DaTscan uptake, and 1 (8%) subject with clinical PD had normal DAT scan. <h3>Conclusions:</h3> Based on functional neuroimaging, 26% of clinically diagnosed AD or DLB subjects had evidence of potential mixed pathologies and 25% were misdiagnosed. <b>Disclosure:</b> Dr. Bouchachi has nothing to disclose. Ms. Truelove has nothing to disclose. Ms. Rawson has nothing to disclose. Mrs. Icenhour has nothing to disclose. Michael Knopp has nothing to disclose. Prof. Wright has a non-compensated relationship as a Board of Directors Member with American Board of Science in Nuclear Medicine that is relevant to AAN interests or activities. Dr. Scharre has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for BrainTest, Inc. Dr. Scharre has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Vascular Scientific. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acadia. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Acadia. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Scharre has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Hickman &amp; Lowder Co.. The institution of Dr. Scharre has received research support from InSightec. The institution of Dr. Scharre has received research support from Alzheimer’s Therapeutic Research Institute (ATRI). The institution of Dr. Scharre has received research support from Eisai. The institution of Dr. Scharre has received research support from vTv Therapeutics. The institution of Dr. Scharre has received research support from National Institute of Health. The institution of Dr. Scharre has received research support from Eli Lilly. The institution of Dr. Scharre has received research support from Johns Hopkins. The institution of Dr. Scharre has received research support from Biogen. The institution of Dr. Scharre has received research support from Roche. The institution of Dr. Scharre has received research support from AZ Therapies. The institution of Dr. Scharre has received research support from Biohaven. The institution of Dr. Scharre has received research support from Novartis. The institution of Dr. Scharre has received research support from Avanir. The institution of Dr. Scharre has received research support from PrecisionMed, Inc. Dr. Scharre has received intellectual property interests from a discovery or technology relating to health care. Dr. Scharre has received intellectual property interests from a discovery or technology relating to health care.

Translation and psychometric validation of the Chinese version of the meaningful and enjoyable activities scale for mild dementia.

To translate 20-item Meaningful and Enjoyable Activities Scale into Chinese and evaluate its psychometric properties amongst Chinese with mild dementia. A cross-sectional study of 450 people with mild dementia recruited from a memory disorders clinic was conducted with the C-MEAS. Raw data were randomly divided into two parts for exploratory factor analysis and confirmatory factor analysis, to evaluate the construct validity. Content validity and reliability were tested by content validity index and Cronbach's α coefficients, respectively. Adaptation results showed that the Chinese version of the scale is adequate for linguistic and content validation. Confirmatory factor analysis indicated a significantly good fit for a three-factor model. Cronbach's alpha coefficient was 0.84 for the overall scale. The C-MEAS for people with mild dementia is a reliable and valid instrument with satisfactory psychometric properties. Future studies should recruit a more representative sample of people with mild dementia in China to verify the applicability of the scale.

Impact of medication optimization and recommendations by clinical pharmacists embedded in a memory disorder clinic

AbstractIntroductionOlder patients with dementia or mild cognitive impairment (MCI) are particularly vulnerable to adverse effects from potentially inappropriate medications (PIMs). Previous studies demonstrated that pharmacist interventions may reduce PIMs, but the impact of pharmacists embedded in an outpatient memory care clinic has not been adequately studied.ObjectiveTo determine the impact of pharmacist recommendations on PIM reduction in older adults with dementia or MCI.MethodsThis prospective observational study within an outpatient neurology center included patients at least 65 years old diagnosed with dementia or MCI. Pharmacists utilized the American Geriatrics Society Beers Criteria, the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions, and the Anticholinergic Burden Scale (ACB) to identify PIMs and reviewed patient charts to make pharmacologic and nonpharmacologic recommendations to prescribers when appropriate per clinical judgment. Primary outcomes included frequency and prevalence of PIMs before versus after pharmacist intervention and rate of acceptance of pharmacy recommendations. Additional outcomes included ACB scores before versus after intervention.ResultsA total of 180 patients were included. Pharmacists made recommendations for 49% of patients, most commonly laboratory monitoring recommendations and medication discontinuations or substitutions. Out of 192 total pharmacist recommendations, 61 (32%) were accepted by providers within the memory clinic. After pharmacist intervention, the frequency and prevalence of PIMs were reduced from average 1.8 to 1.7 PIMs per patient and from 78% to 74% of patients with at least one PIM (p &lt; 0.05). ACB scores were reduced from average 1.5 to 1.3 (p &lt; 0.01).ConclusionPharmacist intervention resulted in a reduction in PIMs and ACB scores in patients with dementia or MCI. Future studies should incorporate a controlled prospective design with scheduled clinical outcomes assessments such as cognitive testing to examine the clinical benefit of pharmacist intervention and explore methods to improve multidisciplinary collaboration between pharmacists and prescribers.

Impact of amyloid PET in the clinical care of US Veterans in a Tertiary Memory Disorders Clinic

AbstractBackgroundPrior studies assessing the clinical impact of amyloid PET have been limited to assessments before and after the scan. We aim to characterize the impact of amyloid PET in a veterans population with cognitive decline by comparing differences in clinical management within two years of follow‐up.MethodsThe current retrospective observational study includes all patients seen for an initial evaluation for cognitive complaints in the Memory Disorders Clinic at the VA Boston Healthcare System from October 2016 to January 2020. Clinical impact outcomes within two years of follow‐up were compared between patients with and without an aPET scan. Poisson regressions, negative binomial regressions, and binomial logistic regression were used for the analysis. Age, cognitive syndrome, follow‐up time, clinical diagnosis after initial evaluation and MoCA scores were used as covariates. Additionally, propensity score matching was performed to balance confounders between the two groups. To further understand the clinical impact outcomes in the aPET group, multiple regressions were performed within the group.ResultsFive‐hundred‐sixty‐five veterans were included in the analysis. Thirty‐five percent of patients underwent aPET imaging in addition to routine diagnostic workup. The study was positive in 72 patients (36.56%). Having an aPET, in addition to the usual diagnostic workup, was associated with a longer follow‐up time, and a higher diagnostic variability at follow‐up. We did not find an association between aPET use and the number of additional diagnostic studies ordered, early cholinesterase inhibitors prescription, or referrals to social work, research and clinical trials. When analyzing the same clinical utility outcomes within the group with an aPET, we found that a positive result was associated with fewer additional diagnostic tests, less diagnostic variability at follow up visits, more cholinesterase inhibitors prescription, and more research referrals.ConclusionsIn medically complex populations, aPET positivity might be lower than prior studies have described, used more to “rule out” than confirm the diagnosis of Alzheimer’s disease. This lower positivity rate results in less robust differences in classically explored clinical impact variables when comparing patients with and without an aPET.