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ACNP 58Th Annual Meeting: Poster Session III www.nature.com/npp ABSTRACTS COLLECTION ACNP 58th Annual Meeting: Poster Session III Neuropsychopharmacology (2019) 44:385–538; https://doi.org/10.1038/s41386-019-0547-9 Sponsorship Statement: Publication of this supplement is sponsored by the ACNP. Individual contributor disclosures may be found within the abstracts. Asterisks in the author lists indicate presenter of the abstract at the annual meeting. W1 moderate cognitive impairment showed statistically significant differences in domain B, but not for 79 memantine-treated The Investigation of Symptoms in Alzheimer’s Disease: patients. Seventy-nine patients treated with antidementia drugs Toward Optimal Strategies of Treatment for the Disease were as follows: donepezil, 22 (3mg/day, 1; 5mg, 5; 8mg, 1; 10mg, 15) ; galantamine, 32 (8mg, 1; 16mg, 6; 20mg, 1; 24mg, 23) ; Yasuhiro Kaneda*, Koudai Yogi rivastigmine, 24 (9mg, 1; 13.5mg, 1; 18mg, 22); memantine, 35 (10mg, 1; 20mg, 34). Among 35 patients treated with memantine, 33 were taking one of three cholinesterase inhibitors (ChEIs). Iwaki Clinic, Anan, Japan Seven (9%) of 79 patients with antidementia drugs were on Background: Cognitive dysfunction in Alzheimer’s disease (AD) is antipsychotics, 4 (5%) were on benzodiazepines, 9 (11%) were on 1234567890();,: usually accompanied by various behavioral and psychological hypnotics, 9 (11%) were on antidepressants, 2 (3%) were on mood symptoms of dementia (BPSD) and dysfunctions in daily activities. stabilizers, and 5 (6%) were on Yokukansan, a traditional Japanese In general, it is considered that there is a worsening of functional Kampo medicine. Case: A 75-year old woman. Mild AD. At initial decline with progressive impairment of cognitive decline in AD, diagnosis, ADAS-cog-J total score was 12.3. Rivastigmine patch but BPSD are worse in the middle stages with moderate cognitive started, and was increased up to 18 mg/day. Subsequently, impairment than those in the early stages with mild cognitive memantine added, and was increased up to 20 mg/day. impairment, and even those in the late stages with severe Rivastigmine was switched to galantamine, and galantamine cognitive impairment. For optimal strategies of treatment for AD, was increased up to 24 mg/day. After 40-month treatment, ADAS- it is quite important to make sure the relations between cognitive cog-J total score was 14.0. function and BPSD/activities of daily living (ADL). Therefore, we Conclusions: There is a worsening of ADL decline with investigated again these relations. In addition, based on the progressive impairment of cognitive decline in AD. BPSD are findings, we present the optimal strategies of treatment for AD. worse in the middle stages than those in the early stages, but Methods: The study patients were 114 visited between January controllable by the treatment. To inhibit decreasing of cognitive 2019 and June 2019 at the Department of Psychiatry, Iwaki Clinic. function in AD, and thus to prevent occurrence of BPSD and Patients fulfilled the following inclusion criteria: diagnosis of AD aggravation of ADL, it is critical to maintain initial good cognitive according to Diagnostic and Statistical Manual of Mental function as much as possible, besides early detection of AD and Disorders, Fourth Edition (DSM-5) criteria. Patients with other initiation of the treatment. For this purpose, we should always types of dementia were excluded from the study. Neurocognitive apply monitoring cognitive function under treatment, and function was assessed using the Mini-Mental State Examination manage limited four antidementia drugs effectively: e.g. combin- (MMSE), and BPSD and ADL were assessed by the ABC Dementia ing memantine with a ChEI or switching a ChEI to another ChEI. Scale (ABC-DS). The ABC-DS, a novel assessment tool for AD is an Keywords: Alzheimer's Disease, BPSD, Neurocognitive Func- effective tool in assessing symptoms and the severity of AD over tioning, Neurocognitive Assessment, ADL time. The 13 items of the ABC-DS are grouped into three domains: Disclosure: Nothing to disclose. domain A, related to ADL function; domain B, related to BPSD; and domain C, related to cognitive function, and the ABC-DS uses a 9- point scale for each question item, with lower scores indicating W2 poorer function. The JMI software (Version 10.0.2) for Macintosh was used to perform the analyses. The clinical assessment scores Computerized Functional Skills Training in Mild Cognitive were compared between the groups by analysis of variance Impairment: Preliminary Results From a Randomized Clinical (ANOVA), followed by post hoc comparisons (Tukey-Kramer HSD). Trial The level of significance was set at p < 0.05. This study obtains the approval from Japanese association of Neuro-Psychiatric Clinics Philip Harvey*, Peter Kallestrup, Lize Tiberica, Sara Czaja Study Ethical Review Board, and the data investigated were fi retrieved from databases and de-identi ed before data analyses. Miller School of Medicine, University of Miami, Miami, Florida, United After data analyses, two cases with successful treatment by States antidementia drugs are presented. Results: The comparisons between three groups of mild (MMSE, Background: Pharmacological interventions aimed at mild >20), moderate (20-11), and severe (11>) cognitive impairment cognitive impairment (MCI) have not been successful to date. showed statistically significant differences in domain A and C, but Recent meta-analyses have suggested that computerized cogni- not in domain B. However, for 35 antidementia drug naïve tive training (CCT) may have beneficial effects on cognition in patients, the comparisons between two groups of mild and people with MCI. An additional feature of MCI is impairments in © American College of Neuropsychopharmacology 2019 ACNP 58th Annual Meeting: Poster Session III 386 everyday functional skills, revealed in particular with performance immediate memory, and delayed memory scores from the Rey on tests of functional capacity. Functional skills training is Auditory Verbal Learning Test (RAVLT). Statin use was defined by facilitated by in many populations by CCT, while CCT alone often whether the study subject was taking a cholesterol lowering drug, fails to yield functional benefits. This presentation presents the including atorvastatin, fluvastatin, lovastatin, pravastatin, pitavas- results of a randomized clinical trial of MCI patients and healthy tatin, simvastatin, rosuvastatin, lescol, mevacor, altocor, livalo, controls where computerized functional skills training (CFST) was zocor, and crestor, at study enrollment. paired in half of the cases with CCT. Statistical Analyses: Linear regression analyses were con- Methods: Healthy older (age>59) individuals (n=32) and ducted with age, education, body mass index (BMI), APOE4 status similarly aged individuals who met diagnostic criteria for mild (i.e. presence of at least one APOE4 allele versus no APOE4 allele), cognitive impairment (MCI; n=26) were randomized to receive and statin use included as model covariates in addition to the 12 weeks of twice-weekly one hour CFST sessions or 12 weeks of interaction term of APOE4 status by statin use. two one-hour sessions split between CCT and CFST. The six Results: Statistically significant interactions were found functional skills trained were technology based and focused on between statin use and APOE4 status in relation to RAVLT total banking, shopping, and medication management. learning and RAVLT immediate memory. Among APOE4 carriers, Results: Paired t-tests found that completion time for all 6 CFST statin use was associated with a 2-point drop in RAVLT total tasks significantly improved from the baseline assessment to the learning score and a 1-point drop in RAVLT immediate memory. final training assessment in both groups of participants, all Whereas, in the APOE4 non-carriers, statin use was associated with ts >4.31, all ps < .001. Average improvement in time to completion a 6-point increase in RAVLT total learning and a 1-point increase in was 45%. Further, none of the 6 tasks improved differentially in RAVLT immediate memory. the MCI and HC samples, as indexed by percentage of Conclusions: Differential effects of statin use in women were improvement from baseline to end of training: all ts <1.66, all ps found in relation to APOE4 status. Statin use in women APOE4 >.12. Finally, combined CCT plus CFST did not differ from CFST non-carriers was associated with better verbal learning and alone on any of the %-change score measures: all t <1.64, all immediate memory performances whereas statin use in women p >.11. APOE4 carriers was associated with worse performances on these Conclusions: Both groups evidenced substantial improvements same tasks. Our findings suggest that sex and APOE4 status are in functional skills performance. CCT supplementation led to important factors in the consideration of statin use, and if similar CFST gains with half as many CFST training sessions. replicated in a larger sample, would inform treatment guidelines Importantly, HC participants who received skills training alone for the statin drugs. required an average of only 6 sessions per task to perfect their Keywords: Statins, APOE4 Allele, Alzheimer's Disease performance. Both groups of participants demonstrated improve- Disclosure: Nothing to disclose. ments in performance across all tasks; MCI participants required more training sessions but learned equivalently. These findings suggest that training interventions can bypass memory impair- W4 ments in MCI and lead to gains in the ability
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