INS NYC 2024 Program

Poster	Poster Session 02 Program Schedule 02/15/2024 08:00 am - 09:15 am Room: Shubert Complex (Posters 1-60) Poster Session 02: Aging \| MCI \| Neurodegenerative Disease - PART 1 Final Abstract #59 Longitudinal Neuropsychological Evaluation Allows Diagnosis of Amnestic Mild Cognitive Impairment with less Severe Cognitive Changes Dona Locke, Mayo Clinic, Scottsdale, United States Blake Langlais, Mayo Clinic, Scottsdale, United States Dixie Woolston, Mayo Clinic, Scottsdale, United States Bryan Woodruff, Mayo Clinic, Scottsdale, United States Cynthia Stonnington, Mayo Clinic, Scottsale, United States Richard Caselli, Mayo Clinic, Scottsdale, United States Category: MCI (Mild Cognitive Impairment) Keyword 1: dementia - Alzheimer's disease Objective: With the recent FDA approval of lecanemab as a treatment for early Alzheimer’s Disease, the ability to detect clinical symptoms of Alzheimer’s Disease as early as possible is ideal. Although biomarkers identify pathology associated with the disease process, they do not characterize the severity of cognitive symptoms. Neuropsychological evaluation characterizes cognitive status and determines if subjective cognitive concerns equate to normal aging or are representative of cognitive changes in advance of normal aging. We have previously demonstrated that research subjects followed longitudinally with neuropsychological evaluation are diagnosed with single-domain amnestic MCI with less severe cognitive changes than patients who have been seen for a single clinical evaluation (Hanson et al, 2018). The objective of the current project is to replicate a similar analysis within a single dataset and expand the analysis to include longitudinal trajectory. We hypothesized that patients with longitudinal neuropsychological assessments during a cognitively normal period prior to a single-domain amnestic MCI (SDAm-MCI) diagnosis would show less impairment in the memory domain at the time of diagnosis compared to patients having SDAm-MCI diagnosed at their first neuropsychological assessment. Participants and Methods: Longitudinal data from the National Alzheimer’s Coordinating Center (NACC) were used updated to June 2022. Study participants were classified into two groups; those who enrolled with normal cognition then progressed to diagnosed SDAm-MCI and remained abnormal (normal-enrollees), and those who enrolled with diagnosed SDAm-MCI and remained abnormal (amnestic-enrollees). Participant characteristics and UDS neuropsychological battery scores were compared between groups at time of SDAm-MCI, and longitudinal mixed-effects model adjusted for sex and age at diagnosis were used to compare rates of cognitive decline post-diagnosis. Eight cognitive domains were evaluated for this study; however, we focus on the memory domain here for brevity. Results: There were 2,582 patients meeting study criteria; 552 normal-enrollees and 2030 amnestic-enrollees. At diagnosis, normal-enrollees were more predominantly female (61% vs 48%; p<0.001) and older (mean 82 vs 75; p<0.001) than amnestic-enrollees. At SDAm-MCI diagnosis, normal-enrollees were 17% less impaired in Logical Memory compared to amnestic-enrollees (mean 9.7 vs 8.3, respectively; p<0.001), and less impaired on Benson Figure Recall and Craft Story Recall. Once diagnosed, the slope of change over time for who began the study as normal steepened compared to their pre-symptomatic change and was steeper than those who had come into the study as abnormal. Conclusions: Longitudinal neuropsychological evaluation allows for diagnosis of single-domain amnestic MCI with less impairment than evaluation at a single time point. In addition, these results suggest that the diagnostic transition from normal to MCI may be an inflection point, at which time decline accelerates. Intervention with anti-amyloid therapy may be especially relevant in this time period—in order to slow or flatten the slope of decline over time when impairment is mildest clinically, and longitudinal neuropsychology is uniquely positioned to identify that earliest time point. Methodologies to increase access to neuropsychology in order to develop longitudinal evaluation protocols may help identify candidates for medical therapies as early as possible maximizing the period of slowed cognitive decline.

Poster

02/15/2024
08:00 am - 09:15 am
Room: Shubert Complex (Posters 1-60)

Poster Session 02: Aging | MCI | Neurodegenerative Disease - PART 1

Final Abstract #59

Longitudinal Neuropsychological Evaluation Allows Diagnosis of Amnestic Mild Cognitive Impairment with less Severe Cognitive Changes

Dona Locke, Mayo Clinic, Scottsdale, United States
Blake Langlais, Mayo Clinic, Scottsdale, United States
Dixie Woolston, Mayo Clinic, Scottsdale, United States
Bryan Woodruff, Mayo Clinic, Scottsdale, United States
Cynthia Stonnington, Mayo Clinic, Scottsale, United States
Richard Caselli, Mayo Clinic, Scottsdale, United States

Category: MCI (Mild Cognitive Impairment)

Keyword 1: dementia - Alzheimer's disease

Objective:

With the recent FDA approval of lecanemab as a treatment for early Alzheimer’s Disease, the ability to detect clinical symptoms of Alzheimer’s Disease as early as possible is ideal. Although biomarkers identify pathology associated with the disease process, they do not characterize the severity of cognitive symptoms. Neuropsychological evaluation characterizes cognitive status and determines if subjective cognitive concerns equate to normal aging or are representative of cognitive changes in advance of normal aging. We have previously demonstrated that research subjects followed longitudinally with neuropsychological evaluation are diagnosed with single-domain amnestic MCI with less severe cognitive changes than patients who have been seen for a single clinical evaluation (Hanson et al, 2018). The objective of the current project is to replicate a similar analysis within a single dataset and expand the analysis to include longitudinal trajectory. We hypothesized that patients with longitudinal neuropsychological assessments during a cognitively normal period prior to a single-domain amnestic MCI (SDAm-MCI) diagnosis would show less impairment in the memory domain at the time of diagnosis compared to patients having SDAm-MCI diagnosed at their first neuropsychological assessment.

Participants and Methods:

Longitudinal data from the National Alzheimer’s Coordinating Center (NACC) were used updated to June 2022. Study participants were classified into two groups; those who enrolled with normal cognition then progressed to diagnosed SDAm-MCI and remained abnormal (normal-enrollees), and those who enrolled with diagnosed SDAm-MCI and remained abnormal (amnestic-enrollees). Participant characteristics and UDS neuropsychological battery scores were compared between groups at time of SDAm-MCI, and longitudinal mixed-effects model adjusted for sex and age at diagnosis were used to compare rates of cognitive decline post-diagnosis. Eight cognitive domains were evaluated for this study; however, we focus on the memory domain here for brevity.

Results:

There were 2,582 patients meeting study criteria; 552 normal-enrollees and 2030 amnestic-enrollees. At diagnosis, normal-enrollees were more predominantly female (61% vs 48%; p<0.001) and older (mean 82 vs 75; p<0.001) than amnestic-enrollees. At SDAm-MCI diagnosis, normal-enrollees were 17% less impaired in Logical Memory compared to amnestic-enrollees (mean 9.7 vs 8.3, respectively; p<0.001), and less impaired on Benson Figure Recall and Craft Story Recall. Once diagnosed, the slope of change over time for who began the study as normal steepened compared to their pre-symptomatic change and was steeper than those who had come into the study as abnormal.

Conclusions:

Longitudinal neuropsychological evaluation allows for diagnosis of single-domain amnestic MCI with less impairment than evaluation at a single time point. In addition, these results suggest that the diagnostic transition from normal to MCI may be an inflection point, at which time decline accelerates. Intervention with anti-amyloid therapy may be especially relevant in this time period—in order to slow or flatten the slope of decline over time when impairment is mildest clinically, and longitudinal neuropsychology is uniquely positioned to identify that earliest time point. Methodologies to increase access to neuropsychology in order to develop longitudinal evaluation protocols may help identify candidates for medical therapies as early as possible maximizing the period of slowed cognitive decline.